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1 

SOCIAL      WORK      SERIES 

THE  SOCIAL  CASE 
HISTORY 

ITS  CONSTRUCTION 
AND  CONTENT 

By 
ADA  ELIOT  SHEFFIELD 

DIRECTOR.  BOSTON  BUREAU  ON  ILLEGITIMACY 


NEW  YORK 

RUSSELL  SAGE  FOUNDATION 
1924 


COPYRIGHT,  1920,  BY 
THE  RUSSELL  SAGE  FOUNDATION 


Printed  October,  1920,  1500  Copies 

Reprinted  March,  1921,  1000  Copies 

Reprinted  January,  1924,  1000  Copies 

Reprinted  May*  1928,  1500  Copies 


WM.  F.  FELL  CO.,  PRINTERS 
PHILADELPHIA 


CONTENTS 

I.  THE  PURPOSE  OF  A  SOCIAL  CASE  HISTORY 
II.  A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

III.  DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

IV.  COMPOSITION  OF  THE  NARRATIVE 
V.  THE  NARRATIVE  IN  DETAIL 

VI.  THE  NARRATIVE  IN  DETAIL  (Continued)  . 


PAGE 

5 

42 

75 
124 
162 

VII.  THE  WIDER  IMPLICATIONS  OF  CASE  RECORDING  200 
INDEX  .  221 


THE  SOCIAL  CASE 
HISTORY 


THE  PURPOSE  OF  A  SOCIAL  CASE 
HISTORY 

^  I  AHE  nature  of  a  social  case  history  is  deter- 
mined  by  the  kinds  of  purpose  it  is  in- 
tended to  subserve.  From  its  subject  matter 
down  to  the  thickness  of  the  paper  it  is  written 
on,  from  the  facts  to  be  selected  as  important  to 
mechanical  devices  for  convenience,  all  questions 
relating  to  it  must  be  decided  in  this  light.  The 
first  step,  therefore,  in  a  discussion  of  the  case 
record  is  to  make  clear  the  use  we  expect  to  put 
this  document  to. 

Defined  in  terms  of  purpose  the  case  history  of 

today  is  a  body  of  personal  information  conserved 

with  a  view  to  the  three  ends  of  social  case  work; 

namely,  (i)  the  immediate  purpose  of  furthering 

5 


THE  SOCIAL  CASE  HISTORY 

effective  treatment  of  individual  clients,  (2)  the 
ultimate  purpose  of  general  social  betterment, 
and  (3)  the  incidental  purpose  of  establishing  the 
case  worker  herself  in  critical  thinking.  These 
ends  did  not  originate  at  the  same  time  with  the 
first  record  keeping,  but  have  come  about  by  a 
slow  development  paralleling  the  development 
of  social  case  work. 

The  Historic  Stages  in  Record  Keeping. — Early 
stages  reflected  the  immediate  purpose. — The  stages 
by  which  case  histories  have  widened  their  func- 
tions show  a  continuity  in  that  they  have  pre- 
served a  common  motive;  namely,  that  of  chron- 
icling the  practical  activities  of  the  agency  in  the 
case.  There  has  been,  however,  a  progressive  en- 
largement of  the  conception  of  "practical  activi- 
ties/' Case  records  of  the  first  stage  were  hardly 
more  than  lists  of  names  (often  even  without 
addresses),  and  jottings  of  money  disbursed,  of 
groceries  and  coal  given,  or  of  children  taken  for 
care.  These  old  records  reflect  case  treatment 
that  would  not  be  regarded  as  "individualized" 
in  the  modern  sense.  Since  in  a  more  primitive 
social  order  the  things  to  be  done  for  a  client  were 
6 


PURPOSE  OF  A  SOCIAL  CASE  HISTORY 


but  slightly  differentiated,  histories  were  corre- 
spondingly meager.  For  example,  the  old  books 
of  a  relief  agency  show  the  following  entries: 

Remarks 

Sick  with  cancer. 

Broken  leg. 

Partly  blind. 

And  3  children. 

Drunk  H.  3  ch.  under 
8. 

Sick,  wife   &   desti- 
tute child. 

Large  family. 

Widow,  etc. 

Destitute. 

Aged  and  destitute. 
Ditto. 
Ditto. 

Died  this  month. 

Injured    by    a    fall 
from  a  horse. 

Lame     &     has     an 
idiot  son. 

Widow,  79  in  March. 

Very  aged. 

Non  compos. 

Wife  of  Joseph.  Left 
her. 

The  above  items  are  taken  from  records  dating 

*  The  names  given  here  (as  elsewhere  in  the  illustrations) 
are  fictitious. 


Name*       Wood 

Cash     Resi- 

feet 

dence 

Mary  Peters          2 

1.50      City 

John  Robbins        2 

2.00      City 

Josephine  Adams  I 

i.  oo      Chy 

Elizabeth  Carter    2 

2.00      City 

Margaret  Riley      I 

1.50  Ireland 

James  Smith          2 

1.50       City 

William  Jones 

i.  oo      City 

Susan  Miller 

I.  oo      City 

Marie  Schmidt 

2.00  Germany 

Martha  Campbell 

i.oo  Scotland 

Julia  Williams 

i.oo  Maryland 

Mary  Winston 

i.oo      City 

Walter  Simpkins 

City 

James  Davis           I 

i.oo  Ireland 

Winifred  Waters    2 

1.50      City 

Annie  Flanagan     I 

i.oo  Ireland 

Jessie  Bryant         I 

i.oo      City 

Michael  Sampson  I 

i.oo      City 

Celia  Cohen           2 

2.00  Russia 

THE  SOCIAL  CASE  HISTORY 

1839  to  1841.  These  ' 'remarks"  of  course  do  not 
represent  all  that  the  almoner  knew  about  his 
needy  people.  Communities  were  small  in  those 
days,  people  knew  their  neighbors'  affairs,  and 
one  did  not  have  so  many  applicants  but  that  he 
could  hold  the  particulars  of  their  situations  in 
memory  fairly  well.  It  should  be  said  that  many 
of  the  same  names  appear  again  and  again 
through  the  records.  We  smile  at  these  "re- 
marks," but  time  may  bring  a  smile  at  our  entries 
in  turn. 

A  history  of  the  second  stage  is  a  brief  report  of 
stewardship.  This  would  include,  in  addition  to 
the  record  of  the  previous  stage,  identifying  facts, 
such  as  age,  birthplace,  religion,  together  with 
something  of  the  client's  story  to  show  that  the 
agency  was  not  helping  indiscriminately  or  with 
favoritism,  that  its  staff  were  selecting  the 
"worthy"  on  whom  to  confer  benefits.  As  in  the 
first  stage,  further  details  might  be  held  in  the 
visitor's  memory.  The  following  illustration  is 
from  a  record  kept  by  a  relief  agency  from  1879 
to  1885,  and  undoubtedly  met  the  standards  of 
that  period : 

8 


PURPOSE  OF  A  SOCIAL  CASE  HISTORY 

Nov.  24,  1879.  Referring  agency.  Very  respectable 
appearing  woman.  Husband  was  floor-walker  at 
Smith's  store.  Made  good  living  but  left  nothing  at 
his  death  20  months  ago.  She  was  then  living  in  Ohio. 
Sister  living  in  New  York  advised  her  to  come  here 
as  could  get  plenty  to  do.  Is  music  teacher.  Capable 
of  doing  many  things  if  had  work,  but  can't  get  it. 
Rent  $5  a  month.  Absolutely  suffering. 

Nov.  24,  1879.  Vis.  Can  teach  music,  crochet,  and 
knitting.  Earns  $3  to  $4  a  week  in  busy  season.  Has 
$10  a  month  from  father's  estate.  No  aid,  but  little 
from  frien  accustomed  to  poverty;  little  ability. 

Nov.  25,  1879.  Vis.  Boys  took  mother's  quilt  for  tent 
and  then  set  it  on  fire.  Teacher  says  Billy  unruly  and 
unreliable. 

Dec.,  1879.  Vis.  Spends  money  quickly,  not  always 
ly.  Poor  manager. 

Dec.  15,  1879.  Vis.  Boy  set  fire  to  shavings  in  an  out- 
house. 

Dec.  19,  1879.  Vis.  Nephew  gives  $5  a  month.  No 
more  aprons  to  sew. 

Jan.  15,  1880.     Vis.    Eldest  boy  sent  to  training  school. 

Feb.  Vis.  Gone  to  Plympton.  Boy  reported  doing 
well  at  training  school.  .  .  . 

Feb.  i,  1884.  Vis.  Mrs.  K.  C.  Ingles  asks  to  have 
something  done  about  the  rent.  Mrs.  X.  has  trouble 
with  varicose  veins  and  is  therefore  prevented  from 
working.  Two  boys  earn  together  $4  and  family  seem 
in  danger  of  being  turned  out.  Sent  for  landlord  P.M. 


THE  SOCIAL  CASE  HISTORY 

Mrs.  X.  herself  comes,  quite  a  ladylike  person.  Born 
in  England  and  speaks  like  a  Yorkshire  woman.  Says 
ownership  of  the  building  has  been  changed  and  settle- 
ment made  with  previous  owner,  but  that  advanced 
rent  is  called  for  by  the  present  one.  .  .  . 
March  16,  1885.  Vis.  Mrs.  X.  asks  more  aid.  A 
brother  in  Indianapolis  in  a  large  clothing  store  sends 
$5.00  or  so  every  month.  Another  brother  in  Mexico 
sent  about  $10  Christmas.  Son  Billy  is  in  Minnesota 
traveling  with  a  photographic  company.  John  lives 
on  a  farm  for  board  and  clothes.  Mary  at  home. 
$5  received  on  8th  went  partly  for  rent. 

In  this  record  the  first  two  entries  on  Novem- 
ber 24th,  with  possibly  that  on  November  25th, 
represent  the  investigation.  It  is  merely  the 
woman's  own  story,  with  no  evidence  of  any  at- 
tempt to  inquire  deeper  into  her  need.  She  makes 
a  good  appearance  and  is  aided  from  time  to  time 
until  she  shows  an  inclination  to  lean  too  much  on 
relief.  Whether  the  one  piece  of  "constructive" 
work  noted ;  namely,  the  sending  of  the  older  boy 
to  a  training  school,  was  done  through  the  good 
offices  of  this  agency  or  not  is  unstated.  The 
history  as  a  whole  is  apparently  designed  to  jus-  / 
tify  the  aid  given  or  refused,  as  was  the  ledger 
10 


PURPOSE  OF  A  SOCIAL  CASE  HISTORY 

record,*  the  difference  being  that  the  fuller  chron- 
ological statement  leaves  less  to  memory  and 
evinces  a  conscious  attempt  at  sizing  up  character 
in  a  rough  way.  This  woman  is  "very  respectable 
appearing,"  "not  accustomed  to  poverty;  little 
ability,"  "spends  money  quickly,  not  always 
wisely,"  "quite  a  ladylike  person."  These  com- 
ments, however,  lead  to  nothing  more  "individ- 
ual" in  the  way  of  treatment  than  the  occasional 
payment  of  rent  or  sending  of  coal.  This  excerpt 
represents  the  turning  point  from  the  second  to 
the  third  stage  of  record  keeping. 

These  first  two  stages  served  only  the  imme- 
diate purpose  of  record  keeping — the  furthering 
of  effective  treatment.  This  they  did  imperfectly, 
partly  because  in  these  stages  case  workers,  as 
their  histories  show,  confined  themselves  to  only 
the  most  obvious  of  their  clients'  needs. 

In  the  third  stage  agencies  undertake  to  make 

their  records  demonstrate  that  their  treatment  of 

their  client  has  been  appropriately  fitted  to  his 

need.    This  stage  corresponds  to  an  increasing 

diversification    which    has    been    taking    place 

*  See  p.  6. 

II 


THE  SOCIAL  CASE  HISTORY 

through  a  number  of  years  in  the  ways  in  which 
a  worker  can  be  of  help  to  a  client.  The  worker 
now  expects  not  only  to  give  coal  and  groceries 
with  discrimination,  but  to  concern  herself  with 
the  clients'  needs  as  to  health,  special  training, 
diet,  employment,  and  so  on.  Such  an  expanding 
function  on  her  part  is  largely  due  to  the  growth 
of  welfare  resources  in  the  community.  Although 
by  the  middle  of  the  nineteenth  century  a  few 
charitable  agencies,  as  they  were  then  called,  had 
been  started  in  the  larger  cities  to  cope  with  the 
more  obvious  social  ills,  the  resources  they  offered 
were  meager  as  contrasted  with  the  enlarged  re- 
sources of  modern  institutions.  Public  authori- 
ties gave  material  relief  in  the  home  or  care  in 
an  almshouse,  where  inmates  were  unclassified. 
Private  provision  for  the  sick  and  for  dependent 
and  wayward  children — two  of  the  earliest  recog- 
nized needs — show  little  of  the  differentiation  of 
treatment  which  marks  the  care  in  the  hospitals, 
dispensaries,  and  institutions  of  today,  with  their 
numerous  clinics  manned  by  specialists  both 
medical  and  social;  or  which  a  modern  city  pro- 
vides for  children  through  a  baby  hygiene  asso- 

12 


PURPOSE  OF  A  SOCIAL  CASE  HISTORY 

elation,  milk  depots,  summer  outings,  truant 
officers,  institutions  equipped  to  study  and  de- 
velop the  individual  child,  and  so  on. 

These  added  resources  touch  the  client's  life  at  V 
so  many  more  points  that  the  present  worker  be- 
comes responsible  for  noting  many  more  data 
than  earlier  workers  had  to  note.  She  cannot  use 
the  various  resources  without  ascertaining  the 
whole  range  of  facts  that  determine  how  they  are 
to  be  applied.  No  visitor  in  a  busy  modern  office 
can  carry  in  her  mind  such  details  of  one  personal 
history  after  another.*  Moreover,  the  fact  that  a 
modern  case  is  apt  to  pass  through  the  hands  of  / 
more  than  one  worker  entails  a  special  need  of 
full  data  in  the  record.  Workers  change,  and  a 

*  One  sometimes  hears  a  worker  claim  that  she  can  trust 
to  her  memory  and  does  not  need  to  record  many  facts.  If 
there  are  people  who  can  do  this,  they  are  so  few  as  to  be 
negligible.  Memory  is  deceptive,  and  can  easily  persuade 
a  well-intentioned  person  to  think  she  is  doing  as  well  by 
her  client  as  she  means  to  do.  The  history  shows  up  her 
efforts  for  what  they  have  actually  amounted  to.  Indeed, 
a  discerning  record  reader  can  hit  close  to  the  mark  in 
taking  the  records  a  worker  writes  as  a  gauge  of  the 
effectiveness  of  her  work.  It  is  not  too  much  to  say  that  a 
case  work  agency  that  keeps  poor  records  is  giving  in- 
effective or  superficial  treatment  to  its  clients. 

13 


THE  SOCIAL  CASE  HISTORY 

substitute  or  successor  must  begin  to  be  helpful 
to  a  client  where  the  previous  visitor  left  off,  and 
with  as  little  loss  of  momentum  as  possible;  the 
visitor  who  knows  the  situation  in  a  client's  fam- 
ily may  not  be  at  hand  when  some  emergency 
arises;  an  employee  other  than  the  visitor  herself, 
who  will  often  be  busy  with  urgent  calls,  may 
have  to  give  a  quick  summary  of  a  client's  history 
to  some  inquiring  agency;  or,  in  a  large  society 
the  supervisor  must  have  some  compendious  y 
evidence  for  estimating  the  quality  of  work  being 
done.  Lastly,  when  social  workers  and  agencies 
teem  as  they  do  today,  the  client,  his  relatives, 
employers,  and  so  on,  must  be  spared  the  repeti- 
tion of  his  story  to  different  people,  as  well  as/ 
the  agencies  themselves  the  duplicating  of  each 
other's  work  that  such  repetitions  mean.  Since 
the  third  stage  of  record  keeping  is  the  prevailing 
one  in  the  better  societies  today,  most  of  the  ex- 
amples in  this  book  illustrate  one  or  another  of 
its  characteristics. 

The  fourth  stage  reflects  an  ulterior  purpose. — 
The  fourth  stage  of  the  case  history  is  an  emerg-  v/ 
ing  one.    At  this  stage  the  record  is  a  social  spe- 
14 


PURPOSE  OF  A  SOCIAL  CASE  HISTORY 

cialist's  report  on  a  typical  instance  of  social  mal- 
adjustment. Where  the  earlier  stages  of  the 
record  marked  the  development  only  of  its  im- 
mediate purpose — the  furthering  of  effective 
treatment  of  individual  clients — the  third  and 
fourth  stages  mark  the  development  of  an  ul- 
terior purpose  for  case  histories — the  advancing 
of  social  betterment.  In  speaking  of  this  as  an 
ulterior  purpose  the  writer  does  not  mean  to 
imply  that  there  will  ever  come  a  time  when  the 
worker's  first  consideration,  whether  in  her  case 
work  or  in  its  recording,  should  not  be  the  welfare 
of  the  client.  The  purpose  of  social  betterment 
should  not  be  thought  of  as  superseding  this  in- 
dividual claim;  rather  should  it  illuminate  the 
case  problem  by  constantly  relating  the  difficul- 
ties of  the  one  client  to  defects  or  maladjustments 
in  the  social  order. 

Records  may  further  this  ulterior  purpose  in 
several  ways:  First,  they  may  afford  a  basis  for 
the  study  of  an  agency's  own  work,  such  as  the 
general  types  of  need  dealt  with,  the  standard  of 
care  maintained,  the  co-operation  with  other  agen- 
cies, and  so  on.  Second  they  may  help  to  stan- 
15 


THE  SOCIAL  CASE  HISTORY 

dardize  the  work  of  different  societies.  If  an 
agency,  without  histories  to  show,  claims  to  have 
all  the  children  in  its  care  medically  examined,  or 
all  of  them  placed  in  well-chosen  homes,  or  to  be 
giving  adequate  allowances  to  all  the  widows 
under  its  charge,  it  cannot  expect  to  be  influen- 
tial in  bringing  others  to  these  standards  with  no 
/"evidence  of  its  accomplishment.  Although  it  is 
true  that  agencies  within  the  same  city  influence 
one  another's  standards  by  conferring  constantly 
about  clients  who  pass  from  the  care  of  the  one 
to  that  of  another,  such  conference^  chiefly  valu- 
able when  based  on  records  which  insure  accuracy 
in  the  interchange  of  statement.  Furthermore, 
well-ordered  records  make  these  standards  clear- 
cut,  bring  them  into  the  open,  for  comparison  and 
criticism,  and  play  an  essential  part  in  forming  a 
consensus  of  opinion  on  the  fundamental  require- 
ments in  diagnosis  and  treatment.  ^Phe  third  way 
in  which  case  recording  may  advance  social  bct- 
terment  is  by  amassing  evidence  of  typical  mal- 
adjustment in  such  a  way  that  it  may  be  avail- 
able when  needed  for  legislation  or  for  preventive 
work.  The  Committee  on  Social  Insurance  of  the 
16 


PURPOSE  OF  A  SOCIAL  CASE  HISTORY 

Massachusetts  legislature,  for  instance,  a  few 
years  ago  asked  a  number  of  the  case  work  agen- 
cies in  the  state  to  submit  what  evidence  they 
could  get  together  bearing  on  the  need  for  health 
insurance.  The  agencies  had  abundant  evidence 
of  the  sort  needed,  which  had  been  gained  in  the 
course  of  their  treatment  of  families,  but  their 
histories  were  too  far  from  being  social  special- 
ists' reports  on  typical  instances  of  maladjust- 
ment for  the  facts  in  them  to  have  been  recorded 
in  a  readily  accessible  way. 

Preventive  work  of  this  and  other  sorts  is  based 
on  the  Identifying  of  socially  significant  types  of 
maladjustment.  This  identifying  is  what  case 
histories  should  do.  They  should  aim  to  show 
the  social  significance  not  only  of  physical,  but  of 
the  borderlines  of  mental  sickness;  they  should 
show  how  sickness  of  either  sort  affects  the.  social 
welfare  of  the  individual  and  his  family;  they 
should  show  also  the  typical  combinations  of 
character  traits  or  of  circumstance  and  character 
which  make  for  various  forms  of  dependency. 
Such  an  ulterior  purpose  for  records  as  that  of 
advancing  social  betterment  will  guide  the  worker 

2  I7 


THE  SOCIAL  CASE  HISTORY 

in  selecting  the  facts  of  most  importance  to  the 
client's  situation.  It  will  draw  her  attention  to 
the  facts  that  identify  the  types  of  need.  The 
development  of  judgment  in  this  selecting,  from 
among  the  numberless  facts  which  the  worker 
learns  about  a  client,  of  those  which  have  sig- 
nificance for  social  treatment  is  for  the  case 
worker  vital  to  her  continued  training;  and, 
since  the  degree  of  discernment  she  exercises  is 
accurately  reflected  in  her  records,  these  afford 
her  a  constant  means  of  self-betterment.  The 
recurring  necessity  for  deciding  what  facts  to  in- 
clude in  the  history,  for  ordering  these  facts  in 
relation  to  one  another,  for  reviewing  and  ap- 
praising her  conclusions,  render  her  increasingly 
skilled  in  contriving  appropriate  treatment.  Her 
ulterior  motive  of  making  her  histories  con- 
vey the  social  typicalness  of  her  cases  thus 
furthers  not  only  their  immediate  helpfulness  to 
the  client  but  their  incidental  efficacy  in  ground- 
ing the  worker  herself  in  habits  of  critical  think- 
ing. 


18 


II 

A  BASIS  FOR  THE  SELECTION  OF 
MATERIAL 

T  Y  7"HAT  facts  should  a  case  record  include? 
Obviously  those  which  are  important,  rele- 
vant, significant  for  treatment^  All  social  case 
workers,  whatever  they  conceive  the  ultimate 
purpose  of  records  to  be,  would  agree  to  this. 
Such  a  statement,  however,  hardly  serves  as  a 
guide  for  one's  choice  from  among  a  mass  of 
facts,  because  at  some  period  in  the  development 
of  the  given  case  any  social  fact  may  conceivably 
be  relevant.  The  present  writer  has  several 
times  had  the  experience  of  displaying  before  a 
class  an  interview  which  seemed  to  her  full  of  ir- 
relevancies,  only  to  find  that  some  degree  of  rele- 
vance could  be  pleaded  for  almost  any  social  fact 
at  some  possible  stage  of  treatment.  What  we 
have  to  do,  then,  is  to  select  such  facts  as  appear 
to  us  to  be  for  the  purpose  of  treatment  relatively 
significant — to  have  more  significance  or  meaning 
19 


THE  SOCIAL  CASE  HISTORY 

than  others;  in  other  words,  we  have  to  record 
those  facts  without  which  we  could  not  decide 
upon  and  carry  out  effective  treatment.  But  we 
become  aware  at  once  that  "relevance  for  treat- 
ment" is  a  test  of  significance  in  facts  that  calls 
for  further  scrutiny. 

Significance  for  Treatment. — A  certain  range  of 
facts  has  come  to  be  generally  accepted  among 
case  workers  as  uniformly  having  significance  for 
their  purpose.*  This  range  would  include  such 
items  as  usually  appear  on  face  cards:  the 
client's  name  and  address,  the  date  and  place  of 
birth,  the  nationality,  addresses  of  physician, 
employers,  and  so  on.  These  are  facts  necessary 
for  identification,  for  evidence  in  any  court  pro- 
ceedings or  law  enforcement  which  the  treatment 
may  include,  or  for  use  as  sources  for  obtaining 
information  and  advice  about  a  client.  The  not- 
ing and  recording  of  such  facts,  therefore,  call  for 
no  act  of  judgment,  no  choice  on  the  part  of  a 
trained  worker.  In  addition  to  this  elementary 
information,  certain  other  types  of  fact  are  gen- 

*  Sears,  Amelia:  The  Charity  Visitor,  Chap.  II.  Chicago 
School  of  Civics  and  Philanthropy,  1913. 

20 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

erally  held  to  be  significant  as  bearing  upon  the 
client's  prospects  of  successful  citizenship.  All 
agree  that  treatment  in  order  to  be  effective  is 
likely  to  have  to  take  into  account  information 
concerning  family  history,  health,  employment,  t 
education,  finances,  character.  Consequently  it 
takes  no  acumen  on  the  part  of  a  worker  to  lead 
her  to  note  some  facts  falling  into  these  categories. 
The  test  of  her  quality  lies  in  her  choice  as  to 
which  of  the  innumerable  facts  possible  for  her 
to  get  and  record  are  those  most  indicative  of  the 
course  she  shall  take  in  rehabilitating  her  client. 
The  fact  and  the  key  conception. — How  are  we 
to  determine  whether  a  given  fact  in  a  given  case 
has  value  or  significance?  We  must  first  inquire 
what  we  mean  by  "significance,"  what  relation- 
ships for  the  fact  constitute  its  significance.  A 
fact  gets  its  significance  from  some  larger  idea  to 
which  it  points,  and  since  that  larger  idea  is  a 
variable  factor,  the  fact's  significance  must  vary 
accordingly.*  For  instance,  a  keen  and  experi- 

*  "All  knowledge,  all  science,  thus  aims  to  grasp  the 
meaning  of  objects  and  events,  and  this  process  always 
consists  in  taking  them  out  of  their  apparent  brute  iso- 

21 


THE  SOCIAL  CASE  HISTORY 

enced  worker  was  called  in  consultation  on  the 
problem  of  a  widow  with  two  children  who  had 
been  receiving  an  allowance  for  some  years.  The 
woman  had  steadily  declined  to  move  from  an 
unsanitary  and  inconvenient  tenement,  giving 
one  reason  and  then  another  for  not  availing  her- 
self of  better  quarters  that  were  found  for  her,  or 
of  moving  expenses  that  were  promised.  The 
consultant  worker  urged  that  careful  inquiry  be 
made  into  the  woman's  character.  She  remarked 
that  in  all  her  long  experience  she  had  never 
known  an  instance  in  which  the  explanation  of  a 
woman's  apparently  unaccountable  obstinacy  in 
holding  on  to  an  undesirable  dwelling  place  had 
not  finally  come  to  light  as  being  something  dis- 
creditable in  her  mode  of  life.  At  the  same  time 
she  recognized  at  least  two  other  explanations  as 
being  possible:  one  the  home  sentiment,  the 
other  inertia.  Many  a  woman  and  man  has  come 
to  feel  the  sentiment  of  home  for  a  spot  to  which 

lation  as  events,  and  finding  them  to  be  parts  of  some  larger 
whole  suggested  by  them,  which,  in  turn,  accounts  for, 
explains,  interprets  them;  i.e.  renders  them  significant." 
Dewey,  John:  How  We  Think,  p.  117,  D.  C.  Heath,  1910. 

22 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

no  one  else  can  see  anything  but  drawbacks;  and 
everyone  at  some  time  in  his  life  clings  to  out- 
worn ways  rather  than  go  to  the  trouble  of  change. 
Immoral  conduct,  home  sentiment,  inertia  are  all 
then  possible  "larger  ideas"  or  "concepts'1  in 
relation  to  which  the  bare  fact  of  this  woman's 
not  moving  may  take  on  significance.  Now  the 
"significance"  which  each  of  these  concepts  gives 
consists  in  the  linking  of  this  fact  to  other  facts 
or  ideas  which  are  thereby  brought  under  view. 
For  instance,  the  concept  "immoral  conduct" 
links  the  widow's  declining  to  move  with  a  doubt 
which  existed  as  to  the  legitimacy  of  her  young- 
est child,  and  with  a  certain  indefiniteness  as  to 
how  she  supplemented  her  allowance.  If  her  ob- 
stinacy pointed  to  such  wrong-doing,  it  connected 
itself  in  thought  with  these  possibilities  and  with 
others,  such  as  her  state  of  health.  On  the  other 
hand,  if  it  indicated  home  sentiment,  it  implied 
emotional  stability,  a  domestic  trait,  and  perhaps 
a  sense  of  unity  with  the  neighborhood. 

In  order  to  grasp  the  full  significance  of  a  fact, 
the  thinker  must  first  have  identified  the  whole 
group  of  items  that  each  conception  relates  it  to. 
23 


THE  SOCIAL  CASE  HISTORY 

His  conceptions,  that  is,  must  be  full  and  distinct. 
A  partly  trained  investigator,  for  instance,  noting 
the  fact  that  a  child  is  pale,  may  at  once  asso- 
ciate it  with  her  as  yet  incomplete  conception  of 
bad  personal  hygiene,  within  which  paleness  is 
related  to  sleeping  with  closed  windows,  lack  of 
exercise,  and  underfeeding.  She  may  thereby 
miss  the  items  actually  operative  in  the  case  of 
the  child  in  question — say  insufficient  sleep  and 
feeding  upon  innutritive  bakery  stuffs — because 
her  conception  of  bad  hygiene  has  been  lacking 
in  one  item  about  sleep  and  vague  in  the  item 
about  feeding.  An  investigator,  therefore,  can 
count  on  grasping  a  fact's  significance  only  when 
her  training  or  experience  has  supplied  her  with 
conceptions  so  copious  and  exact  as  to  focus  all 
the  fact's  relations. 

Treatment  implications  in  the  concept. — When 
one  is  confronted  with  a  doubt  as  to  the  signifi- 
cance of  a  given  fact,  or,  in  technical  phrase,  with 
a  choice  between  conceptions  or  "larger  wholes" 
which  may  give  several  possible  significances  to 
what  would  otherwise  be  an  isolated  fact,  this 
choice  is  determined  by  one's  purpose.  The  case 
24 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

worker's  purpose  is  of  course  social  rehabilitation. 
It  is  evident  that  social  rehabilitation  makes 
her  find  the  significance  of  each  fact  in  a  concept 
charged  with  treatment  implications.  Her  theory 
is  simply  the  obverse  of  her  practice..  To  illustrate, 
given  a  case  of  needy  old  age,  the  worker  will  find 
the  significance  of  its  facts  to  lie  in  their  conse- 
quences for  treatment,  so  that  she  describes  it, 
say,  as  "self-respecting,  not  yet  infirm,  calling  for 
an  allowance,11  or  as  "dissipated-senile,  calling  for 
the  almshouse.11  Take  the  following  instance  of  old 
age  found  in  the  records  of  a  family  agency: 

May  5,  1916.  Called  on  Miss  F.,  living  in  small 
room,  clean,  but  untidy.  She  says  her  father  had  a 
grocery  store  in  X —  — .  He  died  many  years  ago, 
leaving  insurance  and  goodwill  in  store  which  gave  them 
$2,500  in  all.  Miss  F.  was  teacher  in  primary  grade  for 
thirty  years  till  her  mother  became  an  invalid.  She  had 
then  to  give  up  work.  Constant  doctor's  bills  and  an 
expensive  last  illness  used  up  all  their  savings.  Her 
only  relative  is  a  first  cousin  who  is  married  with  grown 
children.  He  lives  in  the  far  West;  she  has  not  heard 
anything  of  him  since  her  father's  death.  She  is  a  mem- 
ber of  the  Baptist  Church,  has  not  attended  service  since 
her  mother  was  so  sick,  because  had  to  save  strength  for 
nursing.  Her  mother  was  heavy  and  had  to  be  lifted. 

25 


THE  SOCIAL  CASE  HISTORY 

Miss  F.  is  slight  in  build,  no  ailment,  strength  used  up  by 
hard  work.  Thinks  she  could  do  a  little  sewing,  is  a 
beautiful  embroiderer,  but  has  to  take  her  time.  Has 
one  old  friend  who  lives  nearby  and  who  sometimes  gives 
her  food.  Otherwise  has  apparently  led  a  lonely  life. 
Appears  nervous  and  fidgety. 

Every  fact  in  this  interview  is  significant,  because 
taken  together  with  the  other  facts  it  points  to- 
ward treatment.  Probably  anyone  would  agree 
that  the  treatment  foreshadowed  is  an  allowance 
for  this  old  lady.  Had  this  been  an  interview 
equally  full  which  gave  no  slightest  hint  as  to 
whether  the  case  was  likely  to  prove  one  for  an 
almshouse  or  for  an  allowance,  we  should  cer- 
tainly say  that  the  worker  had  noted  facts  which 
lacked  significance.  Conversely,  when  we  speak 
of  "trying  out"  different  forms  of  treatment,  we 
must  understand  ourselves  to  be  at  the  same  time 
testing  the  validity  of  different  tentative  con- 
ceptions.* We  might  try  giving  this  old  lady  an 
allowance,  find  she  was  unable  to  care  for  herself, 
and  conclude  that  our  conception  had  been  wrong 

*  Such  conceptions  would  be  tentative  diagnoses.     See 
p.  144- 

26 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

and  that  she  was  of  the  type  "self-respecting, 
infirm,  calling  for  old  ladies'  home." 

In  further  illustration  of  the  fact  that  signifi- 
cance in  case  items  lies  in  their  relevancy  for 
treatment  we  may  compare  the  following  ex- 
cerpts from  two  histories: 

Nov.  8,  1914.  Mrs.  D.  applied  at  office.  She  gave 
visitor  name  of  Mrs.  X.  and  Mrs.  Y.  She  offered  these 
as  references  and  told  visitor  that  she  did  not  expect  any 
aid  today  as  she  wished  to  give  time  for  investigation. 
She  felt  that  it  was  not  necessary  to  tell  anything  else 
about  herself,  and  that  as  long  as  visitor  had  names  of 
two  references,  that  was  all  that  should  be  required.  After 
she  had  talked  for  awhile  she  seemed  greatly  surprised 
that  she  and  visitor  should  have  anything  in  common  to 
talk  about,  and  said  that  she  had  not  expected  to  talk  in 
this  friendly  fashion,  as  she  supposed  everything  would 
be  quite  businesslike. 

This  interview  is  with  a  stranded  old  lady. 
The  only  facts  it  contains  which  are  important 
for  treatment  are  the  addresses  of  the  two  refer- 
ences and  the  absence  of  any  emergent  need  for 
aid.  All  the  rest  of  the  paragraph  is  concerned 
with  the  circumstance  that  the  client  has  be- 
trayed a  common  misconception  of  organized 
27 


THE  SOCIAL  CASE  HISTORY 

family  work,  which  of  course  it  is  the  visitor's 
duty  to  make  every  effort  to  remove  in  order  to 
get  her  confidence,  but  which  in  itself  can  make 
no  possible  difference  in  determining  the  correct 
diagnosis  and  appropriate  treatment  of  the  old 
lady's  need.  The  choice  between  care  by  rela- 
tives, an  allowance,  an  old  lady's  home,  or  the 
almshouse  as  the  best  solution  of  her  troubles 
will  be  independent  of  her  understanding  of  mod- 
ern social  work  methods.  The  visitor's  success  in 
persuading  her  client  to  accept  any  one  of  these 
suggestions  will  depend  in  great  part  on  her  win- 
ning the  old  lady's  confidence.  Since,  however, 
this  is  true  of  every  case  whatsoever,  it  is  only 
when  there  is  evidence  that  the  visitor  is  succeed- 
ing or  failing  to  do  this  in  an  unusual  degree  that 
mention  of  it  needs  to  be  made  in  a  history.  All 
matter,  therefore,  succeeding  the  first  three  sen- 
tences of  the  above  interview,  is  irrelevant  or 
without  significance  for  the  purpose  of  social  re- 
habilitation. 


Dec.  24,  1915.    District  Nursing  Association  (Miss 
X.)  refers.    Their  nurse  has  been  in  twice  to  see  the  baby 

28 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

and  has  found  no  fire.  The  home  looks  very  poor  and 
Miss  X.  feels  that  an  investigation  should  be  made  today. 
Dec.  24,  1915.  Visitor  called  at  3.30  p.m.  and  found 
children  sitting  around  a  red-hot  stove.  Mrs.  S.  had  just 
shaped  four  large  loaves  of  dough  which  were  ready  for 
the  oven.  Two  rabbits  hung  outside  the  window,  and 
Mrs.  S.  said  that  they  were  to  make  a  Christmas  dinner 
for  the  family.  A  quantity  of  clothing  which  had  been 
washed  hung  from  the  walls  of  the  kitchen,  the  line  on  the 
roof  being  three  flights  up.  The  three  rooms  (on  the 
first  floor)  in  which  the  family  live  all  open  on  courts  or 
alleyways  which  admit  no  sun  and  insufficient  light. 
The  tenement  is  not  a  decent  place  in  which  to  live.  Its 
general  gloom  is  increased  by  the  untidiness  within  the 
rooms. 

In  this  interview,  every  fact  given  has  signifi- 
cance for  treatment.  The  red-hot  stove  at  3  p.  m. 
following  upon  no  fire  throughout  the  morning 
suggests  that  Mrs.  S.  may  be  ignorant  or  careless 
about  tending  drafts  and  using  coal  so  as  to  get 
the  most  heat  out  of  it  and  at  the  same  time  to 
save  the  stove,  to  guard  against  fire,  and  to  keep 
an  even  temperature  for  the  children.  Also  her 
having  so  hot  an  oven  just  as  she  was  about  to 
put  in  her  bread  shows  that  she  does  not  know 
how  to  bake.  The  wet  clothes  hanging  where 
29 


THE  SOCIAL  CASE  HISTORY 

they  will  get  as  little  airing  as  possible,  where 
moisture  will  enter  any  crack  in  the  walls,  and 
where  the  consequent  dampness  in  the  room 
would  favor  germs,  not  to  say  vermin,  and  would 
be  proportionately  bad  for  little  children,  the 
untidiness  of  the  rooms  themselves  go  toward 
corroborating  the  conception  "incompetent 
home-maker."  The  lack  of  sun  and  of  light  indi- 
cate "bad  housing/'  If  the  mother  could  find  a 
better  tenement  and  has  not  bothered  to  do  so, 
this  would  again  tend  to  confirm  the  hypothetical 
conception  of  an  incompetent  home-maker.  Both 
poor  home-making  and  bad  housing  are  concep- 
tions of  the  first  importance  for  the  treatment  of 
"family  problems,"  as  they  are  called.  A  choice 
of  interpretations  of  this  mother's  shortcomings 
lies  between  ignorance  and  carelessness,  or  be- 
tween poor  home-making  that  can  be  remedied 
and  that  which  cannot.  More  facts,  got  through 
experiment  perhaps,  would  have  to  determine  the 
decision.  In  getting  these  additional  facts  the 
visitor  would  have  in  mind  the  alternative  treat- 
ments: (i)  sending  a  visiting  housekeeper  to  give 
careful  instructions  in  the  home;  (2)  this  failing 
30 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

to  bring  improvement,  a  mental  examination 
with  the  separation  of  the  children  from  her  as  a 
possible  outcome.  The  visitor  would  not  decide 
on  either  of  these  methods,  but  would  be  guided 
by  the  thought  of  their  possibility  to  noting  any 
further  facts  which  showed  that  an  instructive 
visiting  housekeeper  was  needed  and  would  be 
reasonably  successful,  and  at  the  same  time  any 
facts  which  showed  that  the  conditions  found  on 
that  one  day  were  indicative  of  a  more  serious 
neglect  than  could  be  attributed  to  ignorance 
alone.  Should  such  a  family  situation  occur  in  a 
town  which  had  no  instructive  visiting  house- 
keeper, no  doctor  with  experience  in  diagnosing 
mental  disorder,  no  provision  for  neglected  chil- 
dren, a  visitor  who  thought  only  of  the  individ- 
ual case  would  not  get  the  facts  needed  to  de- 
cide on  any  of  these  treatments.  They  would  not 
seem  significant  to  her,  because  she  could  not 
put  them  to  use.  Aside  from  the  possibility  of 
getting  some  slight  training  for  the  woman  from 
a  volunteer,  the  one  decision  before  her  would  be 
to  give  or  refuse  aid,  and  the  only  facts  she  would 
need  would  be  those  to  help  her  in  this  decision. 
31 


THE  SOCIAL  CASE  HISTORY 

If,  however,  she  had  been  previously  trained,  she 
would  carry  with  her  to  this  town  social  concep- 
tions which  would  give  an  ideal  significance  to  the 
further  information.  It  would  then  be  the  visi- 
tor's duty  to  accumulate  enough  thought-pro- 
voking facts  to  bring  her  new  community  to  the 
point  of  providing  care  for  neglected  children, 
home  training  for  mothers,  and  so  on.  This  pur- 
pose would  give  significance  to  matters  that 
under  other  circumstances  might  have  had  none. 
Vague  concepts  and  a  growing  science. — Some 
concepts  are  vague  in  the  case  worker's  mind 
simply  because  she  is  ignorant,  or  inaccurate  in 
her  habits  as  an  observer.  The  cure  for  such 
vagueness  must  lie  with  the  worker  herself.  Once 
trained  to  be  alert  to  the  symptoms  of  cloudy 
thinking,  the  worker  can  do  much  to  correct  it  in 
any  instance  by  a  careful  review  of  the  case  his- 
tory as  it  lies  before  her.  Other  concepts,  how- 
ever, are  vague  because  certain  of  their  compo- 
nent factors,  although  fraught  with  consequences 
for  treatment,  have  not  yet  been  identified  by  the 
collective  social  thinking  of  the  community.  The 
vagueness  here  is  something  that  the  worker  must 
32 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

note  as  marking  the  skirmish  line  of  a  coming  ad- 
vance in  social  science  that  some  day  will  react 
upon  case  work.  Compare,  for  instance,  the  con- 
cept of "  bad  housing"  with  such  a  concept  as  "  fam- 
ily incohesion."  A  worker  of  any  training  or  ex- 
perience is  hardly  excusable  for  not  having  identi- 
fied the  factors  that  enter  into  bad  housing.  On 
the  other  hand,  a  worker  who  would  interpret 
certain  case  symptoms  by  the  concept  of  "  family 
incohesion"  would  probably  fear  lest  the  term 
suggest  to  other  workers  different  component 
ideas  than  those  she  identified  with  it.  The  con- 
cept is  vague  not  by  fault  of  her  analysis  but  by 
lack  of  corroboration  in  analyses  offered  in  scien- 
tific studies  of  the  family  group.  Of  various 
possible  factors — weak  parental  instinct,  self- 
assertiveness,  obtuseness  to  conventional  senti- 
ment, incompatibilities  in  endowment  and  in- 
equalities in  success,  and  other  forces  too  ele- 
mental and  instinctive  to  be  accurately  named — 
some  are  ideas  which  the  workers  can  hold  only 
tentatively,  expecting  them  to  be  either  con- 
firmed or  revised  as  social  thinking  advances  in 
her  profession.  The  following  interview  from  a 
3  33 


THE  SOCIAL  CASE  HISTORY 

history  in  a  family  agency  shows  the  occurrence 
of  "incohesion"  as  a  vaguely  characterizing  idea 
awaiting  analysis  in  terms  of  ascertained  factors, 
such  as  uncongeniality,  unequal  status,  and  so 
on: 

Feb.  12,  1911.  Called  on  woman's  sister,  Mrs.  Victor 
James,  24  Federal  St.  Mrs.  James'  apartment  is  well 
furnished,  in  a  good  building.  She  said  her  husband  was 
a  carpenter,  works  for  Willard  Bros.  Her  two  children 
came  in  from  school  while  visitor  was  there,  both  well- 
dressed,  healthy-looking,  with  pleasant  manners.  Mrs. 
J.  said  she  had  not  seen  her  sister  for  six  or  eight 
months  as  they  do  not  seem  to  have  much  in  common* 
She  goes  to  see  her  once  in  a  while,  and  has  given  her 
clothing  to  make  over.  Mrs.  Phillips  is  not  handy  and 
doesn't  make  the  most  of  what  she  has.  Her  children 
always  look  shabby  even  when  her  husband  has  work. 
Mrs.  P.  finds  fault  because  Mrs.  J.'s  don't  go  with  hers  at 
school,  but  Mrs.  J.'s  are  older  and  have  their  own  friends. 
It  would  be  impossible  for  Mrs.  J.  to  take  one  of  Mrs.  P.'s 
children  even  temporarily.  All  her  rooms  are  in  use  and 
it  wouldn't  be  right  to  her  own  children  or  to  her  husband. 
Neither  could  she  give  money,  as  it  costs  a  great  deal  to 
bring  up  two  children. 

The  "incohesion"  between  these  sisters  bears 

probably  a  complex  explanation.   A  lack  of  con- 

*  Italics  not  in  the  original. 

34 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

geniality  plus  a  difference  in  means  is  sufficient 
to  account  for  it,  but  uncongeniality  calls  for  an- 
alysis. A  worker  who  recorded  these  facts  not 
merely  because  she  put  them  to  an  immediate 
practical  use  in  organizing  relief  for  her  client, 
but  because  she  had  this  imaginative  forevision 
of  possible  meanings,  would  be  alert  to  catch 
facts  which  count  towards  giving  us  a  clearer 
notion  as  to  what  family  cohesiveness  or  the  lack 
of  it  consists  of  in  general.  Towards  this  concept 
the  knowledge  to  be  sought,  calling  as  it  does  for 
scientific  analysis  of  sentiments  and  emotions, 
must  come  in  the  first  instance  from  students  of 
psychology.  It  should  be  the  part  of  social  work- 
ers, by  noting  down  character  facts,  to  make 
their  own  contribution  to  some  of  the  social 
aspects  of  such  conceptions.  Their  case  records, 
in  that  case,  will  come  to  stand  as  the  evidence 
of  this  contribution. 

A  prerequisite  of  any  advancement  of  knowl- 
edge, or  of  the  identifying  of  the  component 
factors  of  a  conception,  is  that  one  should  be 
aware  of  one's  vagueness.  The  concept  "immoral 
girl "  for  instance,  has  at  certain  important  points 
35 


THE  SOCIAL  CASE  HISTORY 

an  ambiguity  to  which  people  are  often  oblivious. 
Is  any  lapse  of  chastity  "immoral"  regardless  of 
circumstances  and  of  the  degree  of  sentiment 
enlisted,  or  are  there  many  different  degrees  and 
sorts  of  wrong-doing  jumbled  vaguely  together 
in  the  common  idea  of  immorality?  An  aware- 
ness that  distinctions  of  sex  misconduct  signifi- 
cant for  treatment  are  lost  sight  of  under  this 
term  must  precede  any  inquiry  into  the  nature 
and  validity  of  these  distinctions.  There  is  no 
more  urgent  task  before  the  reflective  social 
worker  than  that  of  bringing  to  light  the  vague- 
ness at  innumerable  important  points  in  our 
social  thinking. 

The  reason  why  a  conception  like  "family  co- 
hesiveness"  is  vague  is  that  the  recurrence  of  the 
facts  pointing  to  it  has  not  been  heeded  in  con- 
nection with  the  other  facts  that  gradually  come 
together  to  clarify  the  dawning  concept.  Specific 
cases  of  "family  cohesiveness"  have  been  felt  as 
bearing  a  vague  significance,  but  their  recurrence 
has  not  been  sufficiently  scrutinized  in  relation  to 
accompanying  facts  to  give  them  clear  import. 
It  is  a  social  conception  in  the  forming.  The  mere 
36 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

recurrences,  as  such,  do  not  guarantee  that  it 
will  ever  have  social  significance,  because  many 
recurrent  facts  have  no  consequences  for  the  case 
worker.  On  the  other  hand,  in  order  to  be  sig- 
nificant a  fact  must  be  recurrent;  else  it  suggests 
no  relations  of  cause  and  effect  to  be  counted 
upon.*  For  instance,  we  have  not  noted  the  re- 
current cases  where  a  difference  in  means  accom- 
panies a  separation  of  near  relatives.  If  the 
instance  given  above  is  isolated,  if  there  are  few 
or  no  similar  cases,  then  this  fact  of  the  difference 
in  means  between  two  sisters  has  no  significance: 
it  contributes  nothing  to  the  conception  of 
"family  cohesiveness."  Social  workers,  there- 
fore, who  would  advance  knowledge  in  their 
calling,  need  to  be  on  the  lookout  not  for  recur- 
rence in  itself,  but  for  recurrent  facts  which  their 

*"  Familiar  acquaintance  with  meanings  thus  signifies 
that  we  have  acquired  in  the  presence  of  objects  definite 
attitudes  of  response  which  leads  us,  without  reflection,  to 
anticipate  certain  possible  consequences.  The  definiteness 
of  the  expectation  defines  the  meaning  or  takes  it  out  of  the 
vague  and  pulpy;  its  habitual,  recurrent  character  gives 
the  meaning  constancy,  stability,  consistency,  or  takes  it 
out  of  the  fluctuating  and  wavering."  Dewey,  John:  How 
We  Think,  p.  125.  D.  C.  Heath,  1910. 

37 


THE  SOCIAL  CASE  HISTORY 

imaginative  foresight  leads  them  to  divine  as 
indicative  of  stable  consequences  important  for 
treatment.  In  short,  they  should  frame  a  hy- 
pothesis as  to  what  the  given  fact  means,  and 
then  search  for  confirmation  or  disproof  in  its 
recurrent  instances.  A  fact  which  has  impor- 
tance for  treatment  in  one  case  is  apt  to  recur 
in  other  cases  and  therefore  to  develop  social 
significance,  since  human  nature  is  subject  to 
laws  of  character  (however  imperfectly  under- 
stood), and  since  social  conditions  bear  upon 
whole  classes  of  men.  Should  it  appear  in  the 
illustration  of  the  two  sisters  before  cited  that 
their  difference  in  prosperity,  by  making  against 
the  sense  of  self-importance  of  the  poorer  and 
against  the  vanity  of  the  more  fortunate  sister, 
was  a  constant  source  of  irritation  between  them 
and  so  affected  treatment,  then  we  should  expect 
to  find  that  this  fact  would  prove  to  affect  treat- 
ment in  other  instances  also.  In  this  case,  its  re- 
currence, noted  in  one  record  after  another, 
would  show  a  difference  in  means  as  pointing  to 
the  conception  "lack  of  family  cohesiveness." 
Conceptions  and  preconceptions. — The  number 
38 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

and  variety  of  concepts  which  a  worker  enter- 
tains depends  partly,  as  shown,  upon  her  educa- 
tion and  her  special  training,  and  partly  upon  her 
readiness  to  allow  for  her  own  prejudices.  Pre- 
judice is  apt  to  limit  the  hypotheses  which  a 
worker  admits  into  her  mind.  If  she  feels  im- 
patience with  a  soft  attitude  toward  wrong- 
doing, her  mind  will  discard  offhand  the  hy- 
pothesis of  mental  disorder  as  an  explanation  of 
laziness,  and  will  hold  before  itself  only  that  of 
wilful  self-indulgence.  In  consequence  she  will 
not  be  receptive  toward  the  other  component 
factors  of  the  conception  "disordered  mental  con- 
dition" but  will  instead  be  alive  only  to  those  that 
go  to  make  up  the  conception  of  "contrariness.'1 
In  other  words,  prejudice  will  have  limited  her  to 
one  instead  of  two  possible  explanations  of  her 
client's  difficulty.  The  following  passage  from 
an  interview  suggests  that  the  worker's  inquiries 
had  been  inhibited  by  an  unconscious  bias: 

May  25,  1913.  Called  on  man's  brother,  who  said 
the  trouble  with  man  was  he  didn't  like  work.  Brother 
got  him  a  place  where  he  is  employed  himself.  For  a  few 

days  man  did  splendidly,  then  he  began  to  get  in  late  and 

^/~\ 

39, 


THE  SOCIAL  CASE  HISTORY 

to  dawdle  over  his  job;  finally,  didn't  turn  up  for  two 
days.  Brother  found  he  had  stayed  in  bed  late  and  then 
went  out,  his  wife  didn't  know  where.  This  is  the  second 
time  brother  has  got  him  a  job  which  he  hasn't  taken  the 
trouble  to  keep.  He  has  a  way  of  stopping  work  and 
mooning  that  employers  won't  stand  for.  He  ought  to 
be  put  at  hard  work  by  the  state  and  the  money  given  to 
his  wife.  Brother  says  his  sister-in-law  is  a  good  woman 
and  has  done  more  than  her  share  for  the  family.  The 
only  trouble  with  her  is  she  will  stick  to  man. 

The  foregoing,  it  is  true,  reveals  prejudice  on  the 
part  of  the  brother  interviewed;  nevertheless  had 
the  worker  been  informed  and  open-minded,  she 
would  probably  have  obtained  from  this  brother 
a  statement  as  to  whether  the  man  had  always 
been  like  this,  or  whether  he  had  done  better  at 
any  previous  time;  and  possibly  also  particulars 
about  his  "mooning" — just  how  he  behaved,  how 
long  ago  this  behavior  began,  and  how  often  the 
lapses  occurred.  A  prejudice  for  or  against  either 
of  the  explanations  that  might  suggest  them- 
selves in  this  case  would  close  the  visitor's  mind 
to  a  fair  consideration  of  the  claims  of  the  other. 
The  visitor  should  hold  the  several  possible  mean- 
ings waiting  in  her  mind,  adding  to  her  facts  first 
40 


A  BASIS  FOR  THE  SELECTION  OF  MATERIAL 

toward  one  then  toward  another,  until  she  finds 
in  the  family  history  the  group  of  facts  corre- 
sponding to  those  that  make  up  the  notion  "dis- 
ordered mental  condition"  or  * 'contrariness.'* 

This  familiar  state  of  mind  known  as  suspended 
judgment,  often  thought  of  as  an  inactive  condi- 
tion, is  really  the  reverse;  it  is  an  active  seeking 
for  truth,  whereas  prejudice  is  a  refusal  to  think 
in  certain  directions.  The  prejudiced  mind  feels 
active  merely  because  the  emotions  enlisted  in 
behalf  of  its  object  are  active.  A  lack  of  aware- 
ness of  her  prejudices  on  the  worker's  part  inter- 
feres with  her  fitness  to  write  a  "social  specialist's 
report  on  a  typical  instance  of  social  maladjust- 
ment." The  development  of  this  fourth  stage  of 
record  keeping  demands  open-mindedness  in  the 
specialists  who  are  to  do  the  reporting. 


Ill 

DOCUMENTS  THAT  CONSTITUTE  THE 
HISTORY 


purposes  of  social  case  work  call  for  the 
-*~  use  of  different  documents  for  recording  in- 
formation, each  one  of  which  serves  its  own  sub- 
sidiary purpose. 

The  Face  Card.  —  The  face  card  is  a  blank  form 
for  registering  a  small  range  of  outstanding  facts 
which  are  in  most  constant  use.  This  form  at  one 
time  was  the  whole  history,  even  of  agencies 
doing  a  high  grade  of  work;  it  is  still  the  whole 
history  in  many  agencies  which  for  one  reason  or 
other  are  not  equipped  to  render  intensive  service 
to  their  clients.  When  so  used  it  corresponds  to 
the  second  stage  in  the  advance  of  social  case 
work.* 

This  face  card  has  two  main  purposes:  to 
identify  each  case,  and  to  present  its  basic  facts 
in  a  way  that  enables  the  reader  to  get  a  skeleton 

*Seep.  8sq. 
42 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

outline  of  the  social  situation  at  a  glance.  For 
the  first  purpose  those  facts  which  are  permanent, 
which  will  not  change  with  any  development  in 
the  social  situation,  must  stand  out:  i.e.,  names, 
date  and  place  of  birth,  nationality,  previous  ad- 
dresses. This  the  face  card  does  satisfactorily. 
For  the  second  purpose  a  few  of  the  most  impor- 
tant facts  which  alter  or  fluctuate,  such  as  wages, 
physical  and  mental  condition,  school  grade,  oc- 
cupation, or  even  habits,  have  been  included  by 
many  agencies.  This  inclusion  has  the  serious 
disadvantage  that  any  or  several  entries  may  be 
untrue  a  month  after  they  have  been  written,  in 
which  case  they  had  better  not  be  there  at  all. 
It  is  of  course  possible  to  make  a  new  face  card 
at  intervals,  when  a  number  of  these  facts  have 
changed.*  The  question  then  would  be,  how 
many  and  what  facts  must  change  before  it  is 
worth  while  to  rewrite  the  whole  card.  At  any 
given  moment  some  one  untrue  statement  on 
an  important  point  might  stand  unrevised  until 
enough  information  had  become  obsolete  to  jus- 
tify this  labor.  Agencies  will  probably  disagree 
*  The  Minneapolis  Associated  Charities  does  this. 
43 


THE  SOCIAL  CASE  HISTORY 

as  to  whether  or  not  the  time  spent  in  making 
new  cards  is  offset  by  the  added  convenience  of 
having  a  fuller  outline  at  hand  for  ready  refer- 
ence. A  greater  convenience  it  undoubtedly  is, 
especially  in  a  large  office.  Where  an  agency  deals 
with  hundreds  of  clients  in  a  year,  a  supervisor 
cannot  know  their  varying  histories,  and  must 
be  able  in  case  of  inquiry  or  emergency,  or  indeed 
for  supervision  itself,  to  get  a  rough  sketch  of  a 
client's  setting  in  a  few  minutes.  In  a  society  in 
which  the  treatment  of  clients  is  considered  by  a 
committee,  the  members  of  this  committee  need 
to  get  a  few  outstanding  facts,  in  order  that  de- 
tails which  they  then  learn  later  from  talking 
with  the  visitor  or  from  reading  her  story  of  the 
situation  may  fall  into  place,  ranging  themselves 
in  an  orderly  way  as  related  to  the  especially  sig- 
nificant facts  conspicuous  upon  the  face  card. 
Even  the  visitor  herself  who  is  dealing  with  many 
families  or  individuals  needs  to  be  able  to  bring 
the  particulars  of  the  story  quickly  to  mind  by 
looking  over  the  items  on  a  well-kept  face  card. 
Since  she  knows  just  what  spot  on  the  card  to 
turn  to  for  any  fact  wanted,  it  saves  her  the  time 
44 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

of  looking  through  the  narrative.  This  fuller 
type  of  card,  however,  which  includes  some 
changing  facts,  serves  supervisors,  committees, 
or  visitors  in  no  different  way  from  the  card  that 
gives  only  permanent  facts ;  the  choice  as  to  con- 
venience is  solely  one  of  degree. 

Besides  these  two  main  purposes,  the  face  card 
has  certain  incidental  uses.  It  serves  as  a  basis 
for  making  out  statistics.  Some  of  the  items  en- 
tered on  the  face  card  under  "occupation,"  or 
"read  and  write,"  or  "civil  status,"  for  instance, 
may  represent  what  is  really  a  compromise  term 
for  a  fact  which  otherwise  could  not  be  briefly 
stated.  A  man  may  have  been  a  textile  worker 
for  years,  but  have  just  started  farming  because 
of  his  health.  Which  shall  we  call  his  occupation? 
He  may  not  long  continue  a  farmer,  and  yet 
should  not  return  to  the  mill.  We  decide  to  call 
him  a  spinner.  The  statistical  worker  will  then 
take  this  from  the  face  card  as  his  occupation  and 
be  spared  the  prohibitive  task  of  making  all  such 
decisions  herself.  Again,  take  the  item  "read  and 
write,"  which  is  on  many  cards.  A  man  may  read 
and  write  only  Russian,  or  he  may  write  his  own 
45 


THE  SOCIAL  CASE  HISTORY 

name  and  read  a  few  frequently  used  words 
either  in  Russian  or  in  English.  This  cannot  all 
be  put  on  a  face  card  or  be  included  in  statistics. 
Therefore  we  compromise  and  say  he  reads  and 
writes.  Of  course  this  means  that  some  of  the 
facts  on  a  face  card  or  on  any  such  hard  and  fast 
form  are  not  accurate  without  qualification. 
Such  compromise  truth  in  a  scattering  of  cases 
does  not  invalidate  generalizing  that  is  based  on 
thousands  of  cases.  It  does  matter  to  the  treat- 
ment of  the  individual  client. 
% 

Another  and  important  incidental  advantage 
of  the  face  card  is  the  spur  it  affords  the  worker 
herself  toward  getting  those  facts  which  are  al- 
ways essential  for  treatment.  When  a  visitor  has 
not  obtained  the  information  called  for  by  a 
blank  form,  the  omission  stares  her  in  the  face. 
Every  time  she  looks  over  the  card  she  sees  she 
did  not  verify  a  marriage  or  find  the  employers' 
names,  etc.  The  items  on  the  card,  as  she  fills 
out  one  after  another,  tend  to  become  fixed  in  her 
mind.  She  may  even  have  a  mental  image  of  this 
card  coming  and  going  before  her  while  she  talks 
with  the  client.  This  need  not  prove,  as  might 
46 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

appear  offhand,  a  screen  between  her  and  her 
clients,  but  rather  may  be  merely  a  visualizing 
of  certain  significances  fundamental  for  social 
case  treatment. 

Most  case  work  agencies  use  a  face  card,  vary- 
ing the  items  it  includes  and  their  arrangement 
according  to  the  type  of  case  work  they  deal  in — 
child  welfare,  medical  social  service,  probation— 
and  according  to  local  needs  or  individual  judg- 
ment. A  very  few  agencies,  however,  have  given 
the  card  up  entirely,  preferring  to  use  the  nar- 
rative form  for  all  matter  whatsoever,  from  dates 
of  birth  to  the  facts  showing  in  what  sort  of  fam- 
ily a  wayward  child  should  be  placed.  This  they 
do  partly  because  of  the  impossibility  of  quali- 
fying the  facts  recorded  on  the  face  card,  and 
partly  because  of  the  likelihood  that  items  en- 
tered there  will  merely  repeat  items  in  the  nar- 
rative.* Finding  that  under  pressure  of  work 
their  visitors  or  stenographers  do  not  always  keep 
the  face  card  up  to  date,  and  that  therefore  the 
facts  they  include  in  the  narrative  are  more  cer- 
tain of  being  accurate,  their  general  secretaries 
*  See  p.  70. 
47 


THE  SOCIAL  CASE  HISTORY 

reason  that  the  face  card  is  superfluous.  The 
question  is  whether  the  drawbacks  that  attend 
the  careless  use  of  this  document  outweigh  its 
merits. 

The  lack  of  a  face  card  has  two  disadvantages : 
one  is  that  it  may  lead  workers  to  forget  to  secure 
or  record  some  of  the  elementary  facts  of  social 
case  work;  the  other  that  it  entails  hiding  away 
addresses,  the  insurance  premium,  the  client's 
occupation,  etc.,  in  the  long  narrative  history  by 
obliging  the  worker  to  place  these  constantly 
needed  facts  in  with  other  matter.  The  worker 
cannot  give  time  to  hunt  through  a  whole  record 
for  a  man's  age  or  wages.  This  difficulty  can  be 
obviated  to  a  great  extent  by  paragraphing*  the 
narrative  matter  under  headings  or  marginal  cap- 
tions such  as:  Employment,  Education,  Health, 
Relatives,  Finances.  The  latter  method,  to  be 
sure,  means  that  if  you  want  to  know  merely  a 
man's  wages,  you  may  have  to  read  through  a 
whole  paragraph  under  the  heading  Employment ; 
if  you  need  to  know  a  child's  school  grade,  you 
search  under  Education.  While  such  reading 
*  See  p.  107. 
48 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

takes  a  little  longer  than  a  face  card  requires,  it 
has  the  possible  advantage  that  it  obliges  the 
visitor  to  review  a  range  of  closely  related  facts 
about  her  client  instead  of  noting  just  one  iso- 
lated fact.  One  supervisor  prefers  to  use  a  face 
card  calling  for  but  few  facts,  since  this  forces 
visitors  in  making  decisions  to  take  into  account 
not  merely  the  face  card  facts  and  what  they 
chance  to  suggest,  but  to  consult  the  narrative 
record  and  so  get  the  whole  context  of  the  client's 
history. 

In  planning  a  face  card  it  is  well  for  an  agency 
to  bear  in  mind  five  requisites:  (i)  that  it  should 
be  simple  enough  for  the  eye  to  take  in  its  con-  v 
tents  rapidly;  (2)  that  it  should  keep  facts  of  a 
similar  sort  contiguous  to  each  other — all  ad- 
dresses at  one  side  or  end  of  the  card,  birthplace 
and  nationality  together,  and  so  on;  (3)  that  so 
far  as  is  possible  it  should  include  only  permanent 
facts;  (4)  that  it  should  include  only  facts  which 
can  be  accurately  stated  without  qualifications 
calling  for  space;  and  (5)  that  it  should  be  plotted 
out  so  that  entries  can  be  made  by  typewriter. 
The  third  requisite  is  often  compromised  with  by 
4  49 


THE  SOCIAL  CASE  HISTORY 

giving  space  for  employment,  for  addresses,  for 
other  members  in  the  household,  and  for  school 
grades, — all  these  being  facts  subject  to  more  or 
less  change  with  time.  A  narrow  column  may 
be  included  to  give  opportunity  to  check-mark 
the  verification  of  birth  and  nationality  data, 
court  record,  marriage,  divorce,  legal  separa- 
tion.* 

The  Narrative. — The  addition  of  a  narrative 
sheet  to  the  face  card  marks  the  transition  from 
the  second  to  the  third  stage  of  record  keeping,  f 
As  its  name  implies,  the  narrative  sheet  is  the 
client's  story  told  more  or  less  in  narrative  style. 
Whereas,  when  social  case  workers  went  no  fur- 
ther in  differentiating  treatment  than  to  give 
$1.00  rather  than  $2.00  worth  of  groceries  or  than 
to  send  coal  instead  of  food,  their  record  needs 
were  answered  by  a  ledger  or  a  schedule;  once 
they  began  to  diversify  their  treatment  of  clients, 
adapting  methods  to  different  social  situations, 

*  The  Charity  Organization  Department  of  the  Russejl 
Sage  Foundation  has  recently  published  a  new  face  card 
(form  C.0. 64)  a  sample  of  which  can  be  obtained  by  apply- 
ing to  the  Publication  Department  of  the  Foundation. 

t  See  p.  ii  sq. 

50 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

they  found  themselves  using  a  sort  of  fact  which 
could  no  longer  be  stated  in  one  line  of  a  ledger  or 
in  one  compartment  of  a  blank  form.  For  a  de- 
cade now,  and  in  all  the  larger  and  many  small 
cities,  every  year  has  added  to  the  variety  of  com- 
munity resources  adapted  to  one  sort  of  need  or 
another*  and  has  thus  increasingly  facilitated  the 
delicate  adjusting  of  treatment  to  individual 
client.  Each  such  advance  gives  significance  to  a 
new  set  of  facts.  Diversified  provision  for  the 
treatment  of  sickness,  mental  as  well  as  physical, 
of  unemployment,  non-support,  widowhood,  etc., 
all  mean  an  increase  in  the  number  of  relevant 
facts  which  the  worker  may  need  to  record  in  a 
given  instance.  This  follows  from  two  reasons: 
first,  every  added  community  resource  arises 
from  and  therefore  helps  to  identify  a  different 
type  of  social  need.  In  a  state  which  does  nothing 
in  the  case  of  a  non-supporting  father  but  put  him 
in  jail,  the  only  relevant  facts  for  the  case  worker 
would  be  those  to  determine  whether  his  family 

*  From  March  7,  1910,  to  Nov.  30,  1916,  the  Massa- 
chusetts State  Board  of  Chanty  granted  charters  to  309 
charitable  undertakings  of  one  sort  or  another. 

51 


THE  SOCIAL  CASE  HISTORY 

situation  and  the  public  morals  would  be  bene- 
fited by  his  imprisonment ;  in  a  state  which  pro- 
vides several  different  sorts  of  treatment  for 
different  types  of  non-supporting  father,  the 
worker  must  get  enough  facts  about  a  given 
father  to  identify  the  type  of  non-support  which 
he  represents;  confirmed  deserting  non-support 
(prison  with  payment  of  earnings  to  wife),  in- 
competent non-support  (training  or  mental  ex- 
amination), non-support  associated  with  slack 
home-keeping  or  quarrelsomeness  on  the  wife's 
part  (training  and  supervision  for  the  wife),  and 
so  on.  Second,  it  is  because  every  added  com- 
munity resource  for  the  care  of  maladjusted  per- 
sons, every  new  hospital,  school  center,  child  wel- 
fare society,  or  other  agency,  may  mean  an  added 
social  contact  of  significance  to  the  worker's 
client.  She  must  learn  and  record  what  has  been 
her  client's  contact  with  hospital,  school  center, 
child  welfare  society,  because  these  contacts  all 
enrich  and  modify  the  life  and  character  of  the 
client  and  therefore  must  be  considered  in  diag- 
nosis and  treatment.  The  narrative  history, 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

therefore,  grows  steadily  in  bulk  and  in  impor- 
tance as  social  resources  multiply. 

This  narrative  history  is  itself  divided  by  some 
of  the  children's  agencies  into  one  narrative  for 
investigation  and  one  for  treatment  or  placing- 
out  of  the  children  taken  for  care.  The  division 
corresponds  to  a  division  (made  for  time  saving) 
of  the  office  force  into  a  department  of  investi- 
gators, or  social  diagnosticians,  on  the  one  hand, 
and  of  placing-out  visitors  on  the  other.  Under 
this  arrangement  the  placing-out  visitor  who, 
in  the  course  of  her  special  work  of  supervis- 
ing boarded-out  children,  obtained  facts  bearing 
upon  diagnosis,  or  relating  to  the  family  as  a 
whole  as  much  as  to  the  one  child  in  her  charge, 
would  enter  them  not  in  her  own  narrative  of 
placing-out,  but  in  the  investigation  narrative. 
The  division  makes  it  possible  to  have  a  separate 
narrative  for  each  of  several  children  in  one  fam- 
ily, while  the  same  investigation,  which  covers  of 
course  the  family  situation  and  background, 
serves  for  all. 

The  Budget  Sheet. — Mixed  in  with  the  narrative 
one  often  finds  a  statement  of  the  family  finances: 
53 


THE  SOCIAL  CASE  HISTORY 

income,  budget,  and  relief.  In  the  writer's  opin- 
ion, this  matter  should  be  brought  together  on  a 
separate  sheet.  This  sheet  might  be  the  back  of 
the  face  card,  or  it  might  be  combined  with  some 
other  special  sheet.  The  important  thing  is  to 
have  all  money  items  together  in  bookkeeping 
columns,  so  that  they  may  be  compared  with 
each  other  readily.  Where  they  are  lost  in  a  mass 
of  other  material,  there  is  constant  danger  that 
relief  will  not  bear  the  right  relation  to  income 
and  need.  Practically  it  means  that  relief  is  apt 
to  be  insufficient.  Anyone  familiar  with  case  his- 
tories has  seen  many  from  which  it  would  be  im- 
possible to  tell  without  long  study  what  was  the 
income  or  how  much  aid  was  being  given. 
Budget  making,  of  course,  we  are  but  just  arriv- 
ing at.  The  recording  of  these  items  in  one  place 
so  that  they  and  the  relation  between  them 
should  stand  out  clearly  would  have  several  good 
effects:  (i)  It  would  show  when  a  worker  did  not 
have  these  necessary  facts  and  in  that  way  would 
spur  her  to  get  them;  (2)  it  would  discourage 
purposeless  stop-gap  giving  by  making  it  con- 
spicuous and  would  tend  in  the  same  way  toward 
54 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

more  adequate  relief;  (3)  if  budgets  were  esti- 
mated under  a  dietitian,  as  they  should  be,  it 
would  lead  to  a  more  equitable  standard  of  relief 
as  between  different  families.  The  writer  recalls 
one  meeting  of  public  relief  visitors  at  which  it 
came  out  in  discussion  that  families  made  up  of  a 
dependent  mother  with  three  children  were  being 
aided  according  to  at  least  three  different  scales 
of  living.  Although  there  might  have  been  varia- 
tions in  the  age,  health,  and  other  items  relating 
to  these  mothers  and  their  several  families  that 
would  have  justified  the  apparent  inequity,  the 
visitors  who  were  giving  the  relief  had  not  taken 
this  into  account.  Each  of  them  had  formed  his 
own  general  idea  as  to  what  it  cost  to  feed,  clothe, 
and  shelter  a  woman  and  three  children. 

The  budget  sheet,  then,  should  include:  (i) 
the  family's  income  from  alt  sources,  including 
relief;  (2)  their  property  status,  including  real 
estate  or  savings  as  balanced  against  debts;  and 
(3)  their  outgo.  The  outgo  items  ought  to  com- 
prise both  the  actual  expenditures,  as  kept  track 
of  by  the  family,  and  a  budget  estimate  as  made 
out  for  this  special  family  by  a  dietitian.  Neither 
55 


THE  SOCIAL  CASE  HISTORY 

of  these  estimates  will  always  be  possible  to  get. 
To  induce  hard-worked  mothers  to  keep  weekly 
cash  accounts,  even  for  a  short  period,  is  apt  to 
be  a  difficult  task — often  one  impossible  of  ac- 
complishment. It  has  been  done,  however,  in  a 
certain  number  of  instances,  and  could  undoubt- 
edly be  done  in  more  if  the  effort  were  made.  To 
get  budget  estimates  that  are  based  on  scientific 
knowledge  requires  a  dietitian,  and  dietitians  are 
not  everywhere  available.  Nevertheless,  a  care- 
ful common-sense  estimate  made  by  a  worker 
who  has  informed  herself  on  some  of  the  rudi- 
ments of  feeding  and  of  apportioning  a  small  in- 
come is  a  fair  substitute. 

This  sheet,  if  kept  for  all  allowance  families, 
ought  to  afford  an  accurate  estimate  of  how  far 
short  the  available  relief  funds  fall  of  maintaining 
a  reasonable  standard  of  health  and  decency  in 
the  family  life.  A  comparison  between  estimated 
budgets  and  the  actual  expenditure  of  income  and 
relief  together,  bTy  showing  an  inadequate  outlay 
for  food,  for  instance,  would  make  a  convincing 
appeal  to  the  public  for  increased  funds. 

Several  objections  may  be  offered  to  having 

56 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

this  separate  budget  sheet:  (i)  In  order  to  get  a 
picture  of  the  client's  total  situation,  it  makes 
one  more  sheet  to  look  at  in  addition  to  the  nar- 
rative. But  although  this  operation  takes  a  mo- 
ment to  do,  it  requires  much  less  time  than  does 
the  present  hunting  and  rehunting  for  material 
scattered  throughout  the  whole  record.  (2)  It 
may  take  too  much  time  to  keep  up  such  a  memo- 
randum. This,  however,  could  be  done  by  a 
competent  stenographer,  and  even  if  it  did  take 
more  of  the  visitor's  time,  it  would  more  than 
offset  this  drawback  by  the  clearer  thinking  it 
would  lead  her  to  do — a  gain  of  some  importance 
when  one  reflects  that  cloudy-mindedness  in  so- 
cial case  workers  on  the  subject  of  their  clients' 
finances  does  not  commend  their  services  to 
donors.  (3)  A  separate  conspicuous  sheet  may 
tend  to  make  workers  emphasize  relief-giving  in 
their  efforts  for  families  at  the  sacrifice  of  other 
forms  of  treatment;  it  may  lead  them  to  over- 
look needs  for  vocational  training,  for  change  of 
occupation,  for  amusement,  and  to  rest  satisfied 
with  the  giving  of  an  adequate  allowance.  This 
hardly  seems  a  valid  objection.  What  the  sepa- 
57 


THE  SOCIAL  CASE  HISTORY 

rate  budget  sheet  could  do  is  to  make  the  worker 
think  clearly  on  this  special  topic.  Obliging  her 
to  clarify  her  thoughts  on  one  aspect  of  a  client's 
difficulty  does  not  mean  inviting  her  to  show 
vagueness  on  others,  and  provided  she  is  record- 
ing his  industrial  and  medical  needs  as  clearly  as 
his  financial — and  why  should  she  not? — she  will 
hardly  be  apt  to  overlook  the  more  fundamental 
service  to  her  client. 

The  Medical  Sheet. — A  separate  medical  sheet 
is  in  use  by  the  better  child  welfare  agencies. 
This  sheet  calls  for  a  thorough  physical  examina- 
tion, with  space  usually  for  remarks  and  recom- 
mendations, subsequent  examinations  and  treat- 
ment.* Family  agencies  which  deal  with  sickness 
as  much  as  do  children's  agencies,  might  follow  this 
example.  Since  the  idea  is  spreading  that  every 
citizen,  even  though  apparently  robust,  should  be 
overhauled  by  a  physician  at  intervals  in  order  to 
prevent  unrecognized  weakness  from  developing 
into  troublesome  disease,  it  may  not  seem  uto- 

*  Ralph,  Georgia  G.:  Elements  of  Record  Keeping  for 
Child-Helping  Organizations,  pp.  47-54.  Russell  Sage 
Foundation,  1915. 

58 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

pian  to  suggest  that  every  individual  in  the  care 
of  a  family  agency  should  receive  a  medical  ex- 
amination and  have  a  separate  medical  sheet,  so 
far  as  the  time  and  persuasive  power  of  the 
worker  permit.  Although  the  time  of  the  worker 
and  the  scepticism  of  the  client  will  make  the  sug- 
gestion but  slowly  realizable,  the  medical  infor- 
mation that  such  a  step  puts  at  her  command 
would — as  has  been  shown  by  the  child  welfare 
agencies — at  once  prove  the  basis  for  more  effec- 
tive social  work.  The  lack  of  such  a  foundation 
for  advice  as  to  occupation,  training,  place  of 
dwelling,  or  even  as  to  the  relationship  between 
members  of  a  family  stands  out  in  many  a  con- 
scientious history. 

On  cases  of  recognized  sickness  whose  super- 
vision does  not  call  for  special  skill,  a  number  of 
non-medical  case  work  agencies  are  doing  a  con- 
siderable amount  of  medical  social  service.  When 
they  already  have  the  confidence  of  the  families, 
or  when  the  service  required  is  as  much  or  more 
social  than  medical,  this  seems  a  good  arrange- 
ment. In  order  to  do  it  well  they  should  have 
from  the  physician  in  charge  (l)  his  diagnosis  ex- 
59 


THE  SOCIAL  CASE  HISTORY 

pressed  in  untechnical  words;  (2)  his  prognosis 
so  far  as  he  is  willing  to  make  one;  (3)  his  direc- 
tions for  oversight,  given  in  sufficient  detail  to  be 
readily  followed  by  the  layman.  The  medical 
sheet  should  be  made  out  and  kept  up  either  by 
the  doctor  or  under  his  direction.  Busy  men  can- 
not always  stop  for  clerical  details,  but  the  social 
worker  can  get  either  directly  from  the  doctor  or 
through  the  medical  social  service  department 
(where  there  is  one)  an  exact  statement  which, 
needless  to  say,  she  should  record  precisely  as  she 
receives  it. 

The  Summary. — Even  with  a  budget  and  a 
medical  sheet  on  which  to  draft  off  money  and 
health  items,  the  narrative  history  of  clients  who 
are  in  the  care  of  an  agency  for  years  grows  to 
such  bulk  that  it  becomes  a  matter  of  hours  to 
read  it  through  and  of  added  hours  to  interpret  it. 
The  records  of  a  children's  agency,  which  takes 
children  in  infancy  and  keeps  them  under  super- 
vision until  they  are  established  in  self-support, 
or  those  of  the  family  agencies  which  follow  a 
deserted  mother  until  her  children  are  taking  care 
of  her,  often  amount  to  small  books.  The  ap- 
60 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

praising  of  so  much  material  is  for  most  practical 
purposes  nearly  out  of  the  question.  For  this 
reason  certain  agencies  have  made  "summaries"* 
of  their  records  from  time  to  time.  These  have 
been  written  into  the  body  of  the  narrative,  com- 
monly in  red  ink  to  distinguish  them  from  current 
entries,  or  they  have  been  put  on  separate  sheets 
— one  for  each  summary  made.  These  digests,  as 
indicated,  are  convenient  for  quick  consultation. 
This  facility  is  worth  considering  (i)  wherever 
the  visitor  in  charge  of  a  number  of  clients  is 
likely  to  change,  so  that  a  new  person  must  take 
up  the  work  with  these  same  people  without  hav- 
ing had  time  to  acquaint  herself  with  their  his- 
tories in  detail;  (2)  wherever  a  case  committee 
must  make  recommendations  on  clients  it  has 
known  for  years;  or  (3)  wherever  the  society 
must  answer  inquiries  about  a  family  or  individ- 
ual from  some  interested  person  or  other  social 
agency.  For  the  use  of  the  agency  itself  summa- 

*  A  summary  in  social  case  recording  is  a  digest  of  sig- 
nificant facts  in  the  client's  history.  The  diagnostic 
summary  differs  from  the  usual  form  of  summary  by  stress- 
ing the  conceptions  to  which  these  facts  point. 

61 


THE  SOCIAL  CASE  HISTORY 

ries  should  be  made  periodically,  and  should  be 
condensed  statements  of  the  progressive  develop- 
ment in  the  client's  situation.  The  "diagnostic 
summary"  recommended  by  Miss  Richmond* 
will  probably  be  the  best  method  for  periodic 
statement,  and,  together  with  duplicate  copies 
of  the  occasional  ampler  summaries  written  for 
other  agencies,  will  make  it  possible  for  the 
reader  to  get  an  adequate  r6sum6  of  the  client's 
history.  Indeed,  the  writer  believes  that  the 
diagnostic  summaries  alone  may  be  sufficient  for 
the  needs  of  the  agency  itself,  f 

For  the  use  of  other  agencies  to  whom  the  first 
agency  has  transferred  a  client  or  who  are  co- 
operating to  give  the  latter  some  special  form  of 
care  (mental  examination,  temporary  boarding- 
out  of  children,  prosecution  of  non-supporting 
man),  the  ampler  summaries  will  probably  al- 
ways have  to  be  written.  Some  co-operating 
agencies  want  in  this  document,  besides  identi- 
fying or  permanent  facts,  only  such  a  condensed 

*  Richmond,  Mary  E.:  Social  Diagnosis,  p.  361.     Russell 
Sage  Foundation,  1917. 
tSee  p.  151. 

62 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

narrative  as  will  enable  them  to  decide  whether 
or  not  they  shall  themselves  take  up  the  case  for 
attention.  If  they  decide  to  take  it  up,  they  then 
wish,  if  possible,  to  read  the  whole  history  of  the 
first  agency  themselves.  They  believe — and  un- 
doubtedly often  with  justice — that  no  one  else 
will  select  from  the  history  the  facts  which  they 
will  find  most  useful  in  their  own  special  field. 
This  belief  surely  points  to  gaps  in  the  training  of 
social  case  workers.  Visitors  in  children's  agen- 
cies ought  to  know  enough  about  legal  evidence 
to  make  an  adequate  statement  about  a  delin- 
quent boy  to  a  society  for  preventing  cruelty  to 
children,  just  as  the  secretaries  of  family  agencies 
ought  to  understand  child  welfare  work  suffi- 
ciently to  select  the  pertinent  facts  about  a  deli- 
cate child  they  are  asking  a  child-helping  society 
to  place  out  for  convalescent  care.  A  serious  gap 
in  training  shows  again  when  an  alienist  feels  that 
he  must  take  time  to  go  through  the  whole  of  a 
social  history  because  he  finds  so  few  case  work- 
ers who  can  pick  out  the  sort  of  facts  that  bear  on 
mental  disorder.  The  writer  has  seen  summaries 
on  cases  of  children  made  out  for  a  physician 

63 


THE  SOCIAL  CASE  HISTORY 

which  contained  not  one  fact,  except  that  of  il- 
legitimacy, that  indicated  why  the  case  had  been 
referred  for  examination,  yet  on  turning  to  the 
record  she  found  a  succession  of  significant  inci- 
dents which  any  psychiatrist  would  have  wished 
to  consider.  These  failures  to  select  significant 
information  may  sometimes  be  the  result  of 
haste,  but  in  most  instances  they  probably  point 
also  to  ignorance  as  to  the  kind  of  facts  which 
must  determine  the  action  of  a  co-operating 
agency  or  specialist. 

There  are  co-operating  agencies,  however,  who 
expect  a  summary  to  be  full  enough  so  that  they 
need  not  go  to  the  trouble  of  reading  the  history 
of  the  referring  society.  They  regard  the  making 
of  a  summary  as  an  important  piece  of  co-opera- 
tion over  which  any  society  should  expect  to 
spend  enough  time  to  insure  its  containing  the 
facts  to  indicate  all  the  social  concepts  which  the 
first  agency  sees  involved  in  the  case.  Of  course, 
once  made,  the  same  statement  can  be  used  again 
and  again,  so  long  as  the  client's  situation  con- 
tinues substantially  unchanged,  minor  develop- 
ments being  easily  added.  These  summaries, 
64 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

therefore,  become  a  permanent  and  often  much 
used  part  of  the  case  record. 


FORM  OF  SUMMARY  FOR  CO-OPERATING 
AGENCY 

Referred  For  temporary  placement  of  John,  a  wayward 
boy,  pending  removal  of  family  to  better  neighborhood. 

Name    John  Morey,  born  Chicago,  August  16,  1907. 

Family  Father,  John  Morey,  bora  1883,  Ireland. 
Mother,  Ellen  Jackson,  bom  1886,  Reno,  111.  Irish 
parentage.  Marriage  verified.  Chicago,  Sept.  20, 
1906.  Address  —  — .  Brothers  and  sisters: 
Mary,  bom  1908;  Joseph,  born  1910;  Margaret, 
born  1915. 

Relatives  Paternal:  Sister,  Mrs.  M.  Lynch,  — 
St.  8  children  under  14,  husband,  carpenter,  debts 
from  sickness.  Very  respectable.  Maternal:  Parents, 
Michael  and  Cath.  Jackson,  230  Lindell  Ave.,  man 
janitor.  Brother,  Joseph  Jackson,  12  Maple  St.,  wife 
and  2  children.  Poor,  apparently  self-respecting. 

Religion     R.  C.     Not  regular  communicants. 

Employment  Father  by  trade  a  painter.  At  present 
teamster  for  B—  -  Company.  $i8aweek. 

Education  Father  can  read  and  write.  School  in  Ire- 
land 6  years.  Mother,  Grammar  School.  John  in 
5th  grade,  X  school.  Principal  says  a  fair  scholar, 
keeps  up  with  class.  Is  frequently  absent,  giving  ex- 
cuse of  being  needed  by  mother  at  home.  Gives  no 

trouble  in  class.     Teacher,  Miss  S ,  thinks  him 

5  65 


THE  SOCIAL  CASE  HISTORY 

an  affectionate,  responsive  boy.  The  two  younger 
children  are  slow  at  lessons,  well-behaved.  All  three 
are  poorly  clad  and  have  to  be  sent  home  occasionally 
on  account  of  uncleanliness.  Mary  is  in  4th  grade. 
Joseph  in  the  ist. 

Physical  Condition    Dr.  T ,  who  examined  John 

at  -  -  Dispensary,  says  he  is  undernourished. 
Mother  is  tubercular;  was  at  —  —  Camp  from  Jan. 
to  March;  is  much  improved.  Younger  children  pale 
and  apparently  nervous. 

History  This  family  came  to  attention  6  weeks  ago  when 
the  man  was  ill  with  pneumonia  and  the  woman  asked 
aid. 

Mr.  M.  drinks  a  little  right  along  but  is  never  drunk. 
Worked  for  former  employer  five  years  (according  to 
wife,  two  former  landlords,  and  employer).  He  has 
deserted  his  family  several  times  for  short  periods. 

Mrs.  M.  took  out  a  warrant  for  non-support  in 
June,  1915,  at  the  -  —  Court,  but  withdrew  her 
complaint  a  week  later  when  he  returned  of  his  own 
accord.  Mrs.  M.  a  woman  of  poor  physique,  appar- 
ently; has  no  control  over  the  children.  Visitor  has 
seen  John  running  the  streets  at  some  distance  from 
home  and  has  heard  the  younger  ones  flatly  refuse  to 
obey  their  mother  several  times.  She  is  said  by  a 
former  neighbor,  Mrs.  C.,  Wills  St.,  a  woman  known 
to  be  reliable  by  visitor,  to  have  the  reputation  among 
acquaintances  of  encouraging  the  children  to  steal 
anything  which  can  be  turned  into  money.  Mrs.  M. 
herself  complains  that  man  gives  her  but  little  money 

66 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

to  spend,  on  the  ground  that  she  is  extravagant.  She 
thinks  he  does  not  know  how  much  things  cost.  She 
appears  to  visitor  to  be  amiable  and  fond  of  the 
children,  but  of  weak  and  colorless  character. 

John  is  a  troublesome  little  pilferer,  say  Mr.  P.  the 
market-man  and  Mrs.  F.,  who  keeps  the  notion  store. 
They  have  to  watch  him  carefully  when  he  is  in  their 
stores.  This  has  been  going  on  since  he  was  7  or  8 
years  old.  The  principal  of  the  school  says  he  has  the 
reputation  among  the  other  boys  of  being  a  thief.  He 
sells  to  them  things  he  has  stolen,  sometimes  apparently 
to  buy  food.  Mrs.  M.  told  visitor  that  John  had  twice 
stayed  away  from  home  for  a  couple  of  days  and  re- 
fused to  tell  her  where  he  had  been.  She  says  he  has 
got  in  with  a  gang  of  tough  boys  somewhat  older  than 
he.  One  of  them  is  F.  S.  who  has  been  arrested  twice 
for  playing  craps.  Mr.  Y.  of  settlement  house  says 
this  is  a  tough  gang.  No  one  so  far  as  known  has  tried 
to  get  hold  of  John.  He  is  hard  to  see,  as  he  is  seldom 
at  home  except  to  sleep  and  to  eat.  Mother  will  con- 
sent to  his  being  away  for  the  summer. 
Plan  Medical  examination  for  whole  family.  Aim  to 
induce  man  to  give  woman  more  money  with  the  under- 
standing that  visitor  will  advise  her  in  her  purchasing; 
aim  to  persuade  man  to  move  to  better  neighborhood, 
and  to  interest  himself  in  the  training  of  his  children. 
Clergyman  will  call  on  parents. 

The  foregoing  form,  already  in  considerable 
use,  seems  to  the  writer  one  that  answers  the 


THE  SOCIAL  CASE  HISTORY 

needs  of  the  agency  to  which  a  client  is  referred. 
It  opens  with  an  identification  of  the  case  with  a 
recognized  type  of  problem.  The  arrangement  by 
topics  makes  certain  that  information  on  es- 
sential points  is  included,  and  puts  it  in  a  clear 
and  convenient  form.  Moreover,  with  the  help 
of  this  list  of  facts  drafted  off,  it  is  easier  for  the 
worker  to  write  a  brief,  coherent  statement  under 
the  heading  History.  As  is  evident,  the  summary 
is  not  an  interpretation,  except  in  the  sense  that 
any  orderly  selection  of  facts  represents  the  mag- 
netic action  of  concepts  in  the  selecting  mind. 

One  sometimes  hears  a  worker  say  that  she 
writes  a  different  sort  of  summary  for  different 
agencies — children's,  family  welfare  societies, 
hospitals,  mental  clinics.  All  that  this  means  is 
that  she  lays  emphasis  upon  different  facts.  For 
instance,  the  summary  just  given  mentions  all 
the  facts  about  the  child  to  be  placed  out,  but 
about  the  rest  of  the  family  only  those  which  are 
necessary  to  the  understanding  of  John.  If  the 
summary  were  going  to  a  physician  who  had 
agreed  to  examine  the  woman  with  a  view  to 
determining  her  mental  status,  it  would  need  to 
68 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

enlarge  upon  her  personal  history  with  consider- 
able detail,  and  to  include  about  her  husband  and 
children  only  such  facts  as  would  throw  light 
upon  her  own  condition.  When,  however,  a  sum- 
mary is  to  go  to  an  interested  individual,  a  donor 
or  some  private  person  who  has  referred  a  client 
for  assistance,  it  had  better  be  written  in  a  more 
personal  style,  one  less  official-sounding  to  lay 
ears. 

One  rule  as  to  summaries  the  worker  should 
always  bear  in  mind:  they  should  include  no  fact 
which  is  not  to  be  found  in  the  record  that  pre- 
cedes them.  For  instance,  the  reader  not  infre- 
quently may  discover  in  a  summarizing  letter  to 
a  convalescent  home  or  to  a  co-operating  em- 
ployer some  important  bit  of  information  which 
should  enter  into  the  diagnosis  of  the  client's 
need,  but  which  is  to  be  found  nowhere  else  in  the 
narrative.  The  serious  objection  to  this  is  that  in 
the  summary  it  may  be  given  without  date  or 
source,  so  that  the  reader  cannot  judge  how  much 
weight  to  give  it.  Any  such  fact  ought  to  be  in- 
serted in  some  way  in  the  body  of  the  record  as 
soon  as  the  worker  discovers  its  omission. 
69 


THE  SOCIAL  CASE  HISTORY 

Uncertainties  of  Entry. — In  considering  the  doc- 
uments which  should  enter  into  a  record,  one 
finds  oneself  confronted  in  practice  with  ques- 
tions as  to  which  facts  should  go  on  which  docu- 
ment. Take  to  begin  with  the  face  card  and  the 
narrative  sheets.  The  names  and  addresses  of 
employers  and  relatives,  often  if  not  usually 
found  on  the  face  card,  will  frequently  be  found 
again  in  the  narrative  at  the  beginning  of  an  in- 
terview with  the  employer  or  relative  in  question. 
For  instance: 

March  10,  '16.  D.  S.  called  on  Mr.  James  Rudolph,  77 
Prince  St.;  Mr.  Rudolph  said  he  had  employed  Mr.  S.  a 
year  and  a  half,  and  so  on,  [or  the  following:] 

Vis.  (X.  Y.)  called  on  maternal  aunt,  Mrs.  Ella  Robin- 
son, 126  Maple  Ave.,  Bourneville.  Mrs.  Robinson  took 
boy's  mother  when  she  was  10  yrs.  old,  and  so  on. 

Why  should  this  full  address  be  given  in  two 
places?  The  only  reason  is  that  Mr.  Rudolph  and 
Mrs.  Robinson  may  have  moved  since  the  face 
card  was  made  out,  and  that  the  latter  document 
may  not  have  been  kept  up  to  date.  A  changed 
address  even  of  the  client  himself  may  appear  in 
the  narrative.  The  visitor  dictates  her  interview, 
70 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

includes  the  address  as  an  important  item  she 
must  not  forget,  and  then  drops  the  whole  thing 
from  her  mind.  With  a  stenographer  trained  to 
look  out  for  mechanical  details,  this  new  address 
will  be  put  on  the  face  card  and  omitted  from  the 
narrative;  otherwise  it  may  appear  in  the  nar- 
rative only  or  may  be  duplicated.  So  long  as 
there  is  space  allowed  on  the  face  card  for  such 
changes,  of  course  that  is  where  it  ought  to  go. 
When  a  stenographer  cannot  be  trusted  to  take 
this  degree  of  responsibility,  and  when  the  visitor 
cannot  rely  upon  her  own  clerical  habits,  it  is 
better  to  have  a  certain  amount  of  repetition  than 
to  lose  an  important  address.  No  agency,  how- 
ever, would  want  to  take  for  granted  unbusiness- 
like methods,  even  in  small  things.  Other  facts 
which  occasionally  appear  both  on  the  face  card 
and  in  the  narrative  are,  curiously  enough,  the 
number  of  children  and  the  school  they  attend. 
With  these  facts  staring  the  reader  in  the  face  on 
the  outer  card,  the  interview  within  will  begin 
"Mrs.  Murphy  is  a  widow  with  four  children 
under  nine  years  of  age.  The  two  older  go  to  the 
Park  School."  This  means  that  the  visitor's 
71 


THE  SOCIAL  CASE  HISTORY 

mind  is  not  at  work  while  she  dictates.  Duplica- 
tions between  face  card  and  narrative  involve  a 
waste  of  that  much  time  and  space  and  help  make 
a  history  irksome  to  read. 

Another  division  of  material  must  be  looked 
out  for  between  the  medical  sheet  and  the  narra- 
tive. The  medical  sheet,  as  before  stated,  should, 
if  possible,  be  filled  in  by  the  physician  or  under 
his  direction.  But  there  are  medical  facts  which 
will  come  to  the  visitor's  attention  which  should 
be  included  in  the  narrative,  symptoms  which 
she  should  report  to  the  doctor,  difficulties  in  the 
way  of  getting  his  directions  carried  out,  facts 
as  to  the  health  of  near  relatives.  In  the  following 
entry  it  is  evident  that,  except  for  the  matter 
within  brackets,  the  subject  matter  of  this  entry 
could  not  go  on  a  medical  sheet  intended  for 
medical  opinions  only.  Yet  it  is  of  importance  to 
the  successful  dealing  with  the  health  factor  in 
the  case. 

Feb.  18,  '16.  Jessie  at  Dawson  Dispensary.  Dr.  S. 
[examines  throat,  advises  curetting]  telephones  visitor  at 
Central  Mission  that  with  proper  precautions  there  is  no 
danger  of  infection  to  grown-ups.  Dr.  H.  reports  [he 

72 


DOCUMENTS  THAT  CONSTITUTE  THE  HISTORY 

finds  no  active  trouble  in  the  girl's  lungs,  but  feels  she 
should  have  care  in  a  sanatorium]  and  will  see  that  her 
name  is  put  on  the  waiting  list.  [Before  admission,  how- 
ever, she  should  have  active  lesions  removed  from  her 
throat  and  ought  to  enter  the  hospital  for  this  purpose 
within  a  week  or  ten  days.]  Visitor  replies  parents  will 
never  consent  to  the  operation.  Dr.  H.  says  visitor  may 
promise  that  he  will  not  use  a  knife.  Visitor  confers  wit  h 
Dr.  C.,  family  physician,  who  says  he  will  see  the  parents 
at  his  office  and  try  to  explain  the  situation  to  them  with 
the  hope  that  he  may  persuade  them  to  accept  the  advice 
of  the  dispensary.  Visitor  called  on  the  parents,  who 
agreed  to  talk  with  Dr.  C. 

Then  again  there  is  a  necessary  sorting  of  mate- 
rial between  the  budget  sheet  and  the  narrative. 
A  budget  sheet  can  give  nothing  more  than  fig- 
ures. Other  important  facts  about  the  client's 
financial  situation  which  must  go  into  the  nar- 
rative history  are  the  duration  of  benefits,  the 
real  and  assessed  value  of  property,  particulars  as 
to  mortgages,  debts,  the  kind  of  insurance  policy 
a  client  holds,  etc.  For  instance,  in  the  excerpt 
below  only  the  facts  in  brackets  could  go  on  a 
budget  sheet.  The  remaining  matter  would  con- 
tinue to  be  a  part  of  the  narrative. 

July  10,  '13.    (F.  P.)    Woman  says  her  house  is  assessed 
73 


THE  SOCIAL  CASE  HISTORY 

at  $2,000,  and  that  she  has  a  [mortgage  of  $1,500]  on  it. 
The  taxes  are  $26  a  year,  water  rates  $10,  interest  on 
mortgage  $22.50  a  quarter.  It  is  small,  four  rooms,  un- 
finished upstairs,  but  has  a  plot  of  land  at  the  back  on 
which  they  grew  [vegetables  for  a  supply  through  the 
summer].  She  received  [$500  insurance]  from  her  hus- 
band, from  which  she  paid  funeral  expenses,  doctor's 
bills,  a  grocery  bill,  and  closed  furniture  instalments. 
She  had  $100  left  which  has  gone  for  food  and  clothing  in 
the  three  months  since  her  husband's  death.  She  and 
the  children  are  all  [insured,  amounting  to  $1.50  a  week]. 
This  she  did  immediately  after  man's  death  at  the  advice 
of  the  insurance  agent.  She  now  regrets  the  amount  of 
this  insurance.  [Fred  earns  from  $0.75  to  $1.25  a  week] 
running  errands  for  the  hardware  store  after  school  and 
Saturdays,  and  Mrs.  C.  herself  gets  an  [occasional  half- 
day's  work]  washing  for  a  neighbor  [at  25  cents  an  hour]. 


74 


IV 

COMPOSITION  OF  THE  NARRATIVE 

^  I  AHE  part  of  the  record  which  most  reflects 
the  case  worker's  skill  is  the  current  or  nar- 
rative history.  This  is  the  detailed  story  of  the 
client's  situation,  the  evidence  that  his  need 
lies  in  this  or  that  direction,  and  the  account  of 
the  treatment  given  to  meet  his  need. 

The  Typewriter  and  Narrative  Standards. — This 
current  history  has  been  coming  to  be  of  greater 
bulk  and  to  assume  greater  importance  since 
the  use  of  the  typewriter.  Indeed,  it  is  a 
question  whether  we  should  today  be  thinking 
about  record  keeping  as  an  expression  of  social 
case  work,  were  we  still  held  in  bondage  to  pen 
and  ink.  The  typewriter  is  bringing  about  a 
change  even  in  the  subject  matter  of  our  social 
case  histories.  Writing  of  the  influence  of  labor- 
saving  devices  in  general,  Mr.  Henry  Waldgrave 
Stuart  says:  "Can  it  be  held  that  the  difference 
between  using  a  typewriter  and  'writing  by  hand* 
75 


THE  SOCIAL  CASE  HISTORY 

is  purely  and  simply  a  matter  of  degree — that 
the  machine  serves  the  same  purpose  and  accom- 
plishes the  same  kind  of  result  as  the  pen,  but 
simply  does  the  work  more  easily,  rapidly,  and 
neatly?  .  .  What  has  happened  in  every  case 
like  this  [of  the  evolution  of  a  new  labor-saving 
instrument]  is  an  actual  change  of  standard,  a 
new  construction  in  the  growing  system  of  one's 
norms  of  value  and  behavior.  .  .  .  The 
change  wrought  is  a  transcendence  of  the  earlier 
level  of  experience  and  valuation,  not  a  widening 
and  clarification  of  vision  on  that  level.  And  the 
standards  which  govern  on  the  new  level  serve 
not  so  much  to  condemn  the  old  as  to  seal  its  con- 
signment to  disuse  and  oblivion."* 

That  just  such  a  radical  change  is  taking  place 
in  the  records  of  the  better  social  case  work  agen- 
cies appears  in  the  contrast  between  the  following 
characteristic  passage  from  the  history  of  a  fam- 
ily that  was  well  handled  according  to  the  stan- 


*  Stuart,  Henry  Waldgrave:  "The  Phases  of  the  Eco- 
nomic Interest,"  in  Creative  Intelligence,  p.  288  sq.  Henry 
Holt  &  Co.,  1917. 

76 


COMPOSITION  OF  THE  NARRATIVE 

dards  of  nineteen  years  ago  and  a  passage  from 
a  contemporary  record. 

In  the  former  the  family  was  that  of  a  man 
with  a  wife  and  four  children,  who,  because  of 
repeated  drinking,  had  lost  a  position  he  had  held 
for  ten  years.  He  signed  the  pledge  and  then 
sought  other  work.  The  excerpt  shows  the  kind 
of  faithful  effort  that  was  carried  on  for  months 
to  keep  him  straight  and  to  get  him  started  again. 
He  had  some  fairly  well-to-do  relatives  who 
la-lped  him  in  one  way  and  another  right  along. 

Oct.  2 1, '99.  Agent.  Man  asks  more  groceries.  Agent 
gave  addresses  of  employment  bureaus.  See  Relief. 

Oct.  22,  '09.  Visitor.  Think  it  would  be  well  for 
society  to  supply  3  pairs  shoes. 

Oct.  26,  '99.  Agent.  Man  has  been  to  many  places 
for  work  and  has  interested  a  number  of  people.  Seems 
to  be  trying  very  hard.  Gave  him  order  for  shoes. 

Oct.  27,  '99.  Agent.  Consulted  Mr.  Jones,  State  Em- 
ployment Bureau,  about  man,  who  is  to  call  on  him  this 
afternoon. 

Oct.  3 1 ,  '99.  Agent.  Took  man  chance  for  work  wash- 
ing windows. 

Nov.  3,  '99.     B.  I.    See  Relief. 

Nov.  6,  '99.  Agent.  Man  did  not  go  to  wash  windows, 
perhaps  because  it  rained. 

77 


THE  SOCIAL  CASE  HISTORY 

Nov.  7,  '99.  Visitor.  When  I  saw  man  last  he  thought 
he  had  a  prospect  of  work.  .  .  . 

Nov.  20/99.  Visitor.  Writes:  Man  is  rather  discour- 
aged, though  he  still  keeps  his  pledge  apparently. 

The  agency  finally  secured  steady  work  for  him 
as  general  choreman.  This  position  he  held  for 
a  year,  having  kept  the  pledge  for  eighteen 
months.  Then  drink  and  trouble  with  a  fellow- 
employee  threw  him  and  his  family  into  need 
again. 

The  handling  of  this  situation  was  good  so  far 
as  the  social  knowledge  available  for  case  work 
went  at  that  time.  Where  it  falls  short  from  our 
present  point  of  view  is  in  its  total  lack  of  the 
conception  that  this  man's  weakness  is  one  in- 
stance of  a  socially  significant  type  of  intemper- 
ance. After  his  first  loss  of  employment  the  man 
himself  ' 'admits  faults,  says  no  need  of  his  drink- 
ing but  got  in  with  other  men  who  did,  and  after 
his  mother  died  he  got  discouraged  and  everyone 
seemed  down  on  him."  Two  months  after  his 
second  loss  of  work  he  is  "anxious  for  work. 
Drinking  he  now  regards  with  loathing."  These 
two  entries,  the  only  ones  in  the  whole  record 

78 


COMPOSITION  OF  THE  NARRATIVE 

that  afford  any  insight  into  the  man's  personality, 
raise  the  question  as  to  whether  his  drinking,  as 
is  nowhere  stated  but  as  was  apparently  the  case, 
came  in  sprees  leaving  him  sober  between  times, 
whether  it  was  apt  to  follow  some  emotional 
stress,  like  his  mother's  death  or  the  quarrel  with 
a  fellow-employee,  or  whether  it  was  social  drink- 
ing with  undesirable  acquaintances.  Such  knowl- 
edge would  help  to  identify  this  as  a  recognized 
type  of  intemperance  and  would  at  the  present 
day  lead  to  a  treatment  adapted  to  the  known 
susceptibilities  peculiar  to  that  type,  instead  of  a 
treatment  improvised  upon  the  spur  of  each  oc- 
casion. 

This  pen-and-ink  record  is,  as  appears  from  the 
excerpt,  terse  and  objective.  It  shows  the  worker 
to  have  been  "on  the  job,"  but  concerned  solely 
with  relief  giving  and  the  securing  of  employ- 
ment, with  hardly  an  attempt  at  penetration  into 
the  man's  character.  The  concern  with  per- 
sonality, which  marks  the  case  work  of  today,  is 
of  course  due  to  the  advance  of  social  science, 
but  let  anyone  ask  how  far  busy  visitors  could 
get  in  responding  to  this  concern,  were  they  still 
79 


THE  SOCIAL  CASE  HISTORY 

confined  to  handwriting,  and  he  will  realize  that 
the  typewriter  is  releasing  time  and  energy  in 
ways  that  count  for  the  enrichment  of  our  think- 
ing upon  our  clients*  problems.  As  a  contrast 
to  the  passage  just  discussed,  take  the  following 
interview  from  a  record  of  a  child-placing  agency. 
It  is  from  the  history  of  a  girl  of  sixteen  who  is 
normal  in  so  far  as  tests  indicate,  but  who,  as  is 
apparent,  does  not  "make  good." 

"April  10,  '18  (F.  J.)  Visited  foster  mother.  Harriet 
has  been  kept  out  of  school  for  a  month  owing  to  measles 
in  the  foster  home.  [Has  been  on  the  whole  quite  help- 
ful.] Has  usually  been  glad  to  assist  foster  mother  [in 
every  way]  but  can  only  work  under  supervision.  When 
left  downstairs  alone  with  the  work  while  foster  mother 
caring  for  the  children,  work  always  sure  to  be  slighted. 
Unless  room  is  daily  inspected,  will  not  keep  it  in  order. 
With  [but]  one  exception  has  shown  good  disposition. 
When,  on  account  of  illness  in  the  home,  foster  mother 
had  to  give  up  making  the  [serge]  dress  which  she  had 
planned  to  do  [at  home],  and  the  dress  instead  had  to  be 
purchased  at  the  store,  H.  flew  into  a  temper  and  refused 
to  speak  to  foster  mother  for  a  number  of  hours.  She  is 
at  times  sulky,  but  if  [wholly]  disregarded  these  spells 
usually  pass  by  in  a  short  time.  [Took  mother's  death 
quite  seriously.]  Wrhen  first  told  of  mother's  death  was 
apparently  deeply  upset,  but  since  speaks  of  her  quite 
80 


COMPOSITION  OF  THE  NARRATIVE 

casually.  [Troubled  about  H.'s  attitude  toward  death. 
Talked  with  her  at  length  about  it  when  her  mother  died 
and]  H.  insisted  that  she  did  not  believe  there  was  any 
future  life.  [Unable  to  change  her  feeling  in  the  matter.] 
Has  spoken  to  clergyman,  Mr.  S.,  who  will  [at  the  first 
opportunity]  talk  the  matter  over  with  H.  H.  has 
missed  church  attendance  and  was  [very]  glad  to  return 
last  Sunday  to  sing  in  the  choir  and  Sunday  school  class." 

It  is  evident  that  the  degree  of  interest  in  per- 
sonality displayed  in  this  interview  amounts  al- 
most to  a  difference  in  the  kind  of  interest  shown. 
The  visitor,  in  consultation  with  a  psychiatrist, 
is  attempting  to  modify  definite  traits  in  the 
patient.  As  a  recorded  interview,  the  paragraph, 
it  is  true,  shows  a  number  of  superfluous  words 
and  statements,  those  in  brackets  being  what  the 
present  writer  regards  as  such.  It  is  because  dic- 
tation to  a  stenographer  lapses  into  the  prolix 
and  redundant  style  of  ordinary  talk  that  it  is 
more  necessary  than  in  the  early  years  of  case 
work  for  us  to  emphasize  the  selection  of  those 
facts  that  have  the  highest  relevance,  and  the 
casting  aside  of  those  which  do  not  bear  upon  the 
major  process  of  treatment.  The  whole  matter  of 
the  selection  of  significant  facts  would  hardly 
6  81 


THE  SOCIAL  CASE  HISTORY 

arise  were  we  still  obliged  rigidly  to  limit  the 
length  of  entries  because  of  time  pressure  and  the 
irksomeness  of  writing. 

The  Disposal  of  Ephemeral  Matter. — "Behold- 
me-busy"  details. — Perhaps  the  most  conspicuous 
sort  of  irrelevance  that  cumbers  our  present-day 
records  is  that  of  facts  which  have  only  an  ephem- 
eral value.  Of  this  sort  are  items  relating  how  the 
visitor  has  spent  her  time.  One  reads  histories  in 
which  the  narrative  is  constantly  interrupted  by 
what  is  virtually  an  accounting  to  the  supervisor 
or  superintendent  for  time  spent.'  The  current 
history  is  thus  made  to  fulfil  the  function  of  a  day 
book.  That  some  superintendents  want  this  done 
excuses  the  visitor,  but  does  not  remove  the  ob- 
jections to  the  method.  Such  entries  often  report 
unsuccessful  telephone  calls  or  visits  to  people 
not  at  home: 

Oct.  5,  '13.  Called  on  sister,  Mrs.  X.,  21  Pearl  St.  No 
one  in. 

Oct.  6/13.    Telephoned  Mrs.  X.    No  answer. 

Oct.  6/13.  As  was  in  neighborhood  on  another  errand 
called  again  on  Mrs.  X.  Neighbor  says  often  away  all 
day  nursing,  and  sometimes  till  late  in  evening. 

Oct.  7,  '13.    Wrote  Mrs.  X.  for  appointment  to  call. 

82 


COMPOSITION  OF  THE  NARRATIVE 

Oct.  9/13.  Letter  from  Mrs.  X.  making  appointment 
for  Oct.  9th. 

Oct.  9/13.  Called  on  Mrs.  X.  She  lives  in  one  room, 
and  so  on. 

All  this  merely  explains  why  there  was  a  delay 
of  four  days  in  finding  out  whether  this  sister 
would  combine  housekeeping  with  the  client.  If 
the  visitor  thought  it  necessary  to  account  for 
such  delay,  she  could  enter: 

Oct.  9/13.  After  calling  twice  and  telephoning  with- 
out getting  Mrs.  X.,  went  to  see  her  by  appointment. 
She  is  often  away  nursing  all  day  and  sometimes  in  the 
evening.  She  lives  in  one  room,  and  so  on. 

Recorded  thus  briefly,  an  explanation  to  the 
'supervisor  is  as  unobjectionable  as  it  can  be 
made.  It  offers  the  minimum  of  interruption  to 
the  reader's  attention.  The  same  sort  of  irrele- 
vant break  in  the  narrative  shows  more  patently 
in  the  record  of  a  half-trained  visitor: 

May  12,  '07.  Family  referred  by  Mr.  F.  in  letter  of 
May  9.  (The  reason  visitor  did  not  call  on  family  sooner 
was  because  the  letter  was  misdirected  and  was  there- 
fore delayed  two  days  in  the  mail.)  Mr.  F.  writes,  and 
soon. 

Although  we  are  inclined  to  be  amused  by  the 
83 


THE  SOCIAL  CASE  HISTORY 

obvious  inappropriateness  of  this  detailed  self- 
justification,  and  although  it  is  addressed  to  the 
supervisor  in  a  more  direct  way  than  is  the  list  of 
unsuccessful  calls  and  telephoning  in  the  pre- 
vious illustration,  it  is  in  effect  the  same  sort  of 
irrelevance.  In  each  instance  the  important  con- 
cerns of  the  client  are  dropped  for  a  space  while 
the  visitor  makes  it  clear  that  she  is  on  the  job 
and  earning  her  pay.  Such  an  interruption  to  the 
reader's  train  of  thought  makes  a  record  tiresome 
to  consult  by  beclouding  information  that  is  sig- 
nificant. 

Process  Details. — Other  facts  of  but  temporary 
value,  are  items  as  to  the  mechanical  process  of 
getting  things  done: 

May  i,  '17.  Telephoned  to  aunt  [asking  her  if  the 
two  little  boys  could  stay  at  her  home  for  the  present]. 
She  says  that  they  can  stay  there  [and  visitor  promised  to 
bring  clothing  on  the  4th]. 

May  4,  '17.  Took  clothing  for  boys.  They  and  the 
aunt  appreciative.  Relation  between  them  appears  affec- 
tionate. [Arranged  to  call  to  take  John  to  dispensary  on 
7th.] 

May  7,  '17.  Took  John  to  dispensary.  Dr.  P.  ad- 
vises hospital  care. 


COMPOSITION  OF  THE  NARRATIVE 

May  8,  '17.  Telephoned  to  aunt  that  hospital  care 
would  be  necessary  for  John  and  arrangements  will  be 
made  for  boy  as  soon  as  possible. 

[May  8,  '17.  Referred  case  to  Public  Charities  Dept. 
Miss  F.  not  in.  Will  telephone  visitor  following  morn- 
ing.] 

[May  9,  '17.  Consulted  Public  Charities  Dept.  Said 
that  boy  could  be  sent  to  hospital  on  the  lothany  time 
before  3.30  p.m.] 

[May  9,  '17.  Telephoned  to  boy  to  meet  visitor  at 
12.30  on  May  ioth.] 

May  10,  '17.    Took  John  to  City  Hospital. 

Taking  out  the  less  significant  parts  of  this  proc- 
ess these  entries  reduce  to: 

May  i,  '17.  Telephoned  to  aunt,  who  says  that  boys 
can  stay  at  her  house  for  the  present. 

May  4,  '17.  Took  clothing  for  boys.  They  and  the 
aunt  appreciative.  Relation  between  them  appears 
affectionate. 

May  7/17.  Took  John  to  dispensary  for  examination. 
Dr.  S.  advises  hospital  care. 

May  8,  '17.  Telephoned  aunt  of  doctor's  advice  and 
told  her  arrangements  will  be  made  for  boy  as  soon  as 
possible.* 

May  10,  '17.    Took  John  to  City  Hospital. 

*  There  might  be  a  difference  of  opinion  as  to  whether  or 
not  this  entry  needs  to  be  kept. 

85 


THE  SOCIAL  CASE  HISTORY 

It  will  be  observed  that  much  of  what  is  left 
here  is  also  a  part  of  the  process.  The  distinction 
between  the  entries  cut  out  and  those  remaining 
is  that  each  one  of  the  latter  has  a  relevance  for 
future  treatment,  whereas  the  excised  portions 
are  of  importance  only  until  the  clothing  was 
taken  to  the  boys,  until  John  was  got  to  the  dis- 
pensary and  later  into  the  hospital.  After  the 
few  days  necessary  to  bring  these  ends  about,  the 
process  of  doing  the  things  did  not  matter.  For 
this  short  period,  it  is  true,  these  arrangements 
need  to  be  accurately  remembered.  Therefore, 
along  with  all  ephemeral  memoranda,  they 
should  be  kept  in  a  note-book,  or  a  tickler.*- 

In  her  revised  edition  of  The  Charity  Visitor,f 
Miss  Amelia  Sears  refers  to  this  sort  of  cumbering 
of  the  record  with  unnecessary  matter.  She 
writes:  "The  statement  of  the  work  done  for  the 
family  should  be  as  brief  as  possible — the  mere 

*  A  file  arranged  in  order  of  dates,  so  that  memoranda 
can  be  slipped  in  under  the  date  on  which  matter  is  to  be 
attended  to  and  then  put  forward  to  another  date,  in  case 
of  a  revisit  or  a  prevented  visit. 

fThe  Chanty  Visitor,  p.  41.  Chicago  School  of  Civics 
and  Philanthropy,  1917. 

86 


COMPOSITION  OF  THE  NARRATIVE 

statement  is  sufficient.  Record  only  the  finished 
product,  not  the  process."  That  Miss  Sears  has 
in  mind  when  she  thus  speaks  of  the  "process" 
only  such  processes  as  are  of  temporary  impor- 
tance is  evidenced  by  the  following  paragraph:* 

"Thus,  a  visitor  engaged  in  securing  a  diag- 
nosis of  a  patient's  illness,  his  admission  to  a 
hospital,  and  his  convalescent  care  should  omit 
any  'write-ups'  until  able  to  record  accomplished 
fact  in  a  conclusive  and  definite  manner.  Pos- 
terity will  not  care  how  many  hospitals  she  had 
to  consult  or  how  much  effort  she  put  forth;  all 
the  next  generation  of  workers  who  handle  that 
case  record  will  consider  is  what  the  diagnosis  was 
and  what  the  outcome." 

Miss  Sears,  no  more  than  any  of  us,  would  ad- 
vocate the  omitting  of  such  parts  of  the  process 
as  may  affect  succeeding  treatment  in  important 
ways  for  a  considerable  period  of  time.  The  case 
worker  must  bear  in  mind  that  the  treatment  she 
puts  into  effect  actually  alters  the  client's  situa- 
tion in  its  economic,  or  medical,  or  psycho-social 
aspect.  In  the  last  illustration,  for  instance,  a 
*  Op.  cit.t  p.  40. 


THE  SOCIAL  CASE  HISTORY 

new  worker  taking  up  the  supervision  of  the  two 
boys  after  John  is  in  the  hospital  will  find  a 
problem  which  differs  from  the  first  worker's  in 
the  very  important  respect  that  the  boys  are  on 
a  visit  with  a  responsible  relative,  and  that  one 
of  them  is  under  adequate  medical  care.  The 
facts,  then,  that  John's  condition  was  diagnosed, 
and  that  he  is  being  treated  at  an  institution,  al- 
though a  part  of  the  "process"  of  getting  him 
properly  established  under  conditions  favoring 
development,  are  of  paramount  importance  for 
future  treatment.  In  this  connection  a  super- 
visor of  case  work*  comments: 

Even  the  best  case  workers,  however,  have  a  tendency 
to  set  forth  investigation  far  more  fully  and  exactly  than 
they  do  treatment.  .  .  It  [investigation]  is  an  impersonal 
thing  in  the  sense  that  in  writing  up  the  case  record  of  in- 
vestigation it  is  .  .  .  usually  inadvisable  for  them 
to  include  much  about  their  own  actions  or  reactions. 
In  recording  treatment  the  natural  modesty  of  the  good 
case  worker  often  prevents  her  recording  in  full  the  proc- 
esses by  which  desirable  ends  were  gained.  It  is  com- 
mon to  find  a  successful  case  record  in  which  the  results 
appear  unwarranted  ....  as  coming  from  the 
treatment  which  was  recorded. 

*  Joanna  C.  Colcord.    From  an  unpublished  manuscript. 
88 


COMPOSITION  OF  THE  NARRATIVE 

As  an  illustration  of  what  has  just  been  said,  a  district 
secretary  once  told  her  supervisor  about  the  success  of  her 
assistant  in  solving  an  unusually  difficult  problem  in  in- 
temperance— that  of  a  man  who,  though  a  capable  work- 
man and  a  man  of  good  character,  was  universally  dis- 
liked by  his  fellow-workmen,  and  whose  pride  and  pique 
led  him  to  form  drinking  habits.  A  great  deal  of  careful 
work  was  done,  including  medical  care  for  the  man  and 
his  family  and  his  reinstatement  with  a  former  employer 
who  knew  his  weaknesses;  and  he  was  induced  to  keep 
straight  for  a  period  of  several  months.  As  the  holidays 
approached  the  worker  realized  that  this  was  going  to  be  a 
time  of  particular  strain  for  her  client,  and  on  the  night 
before  Christmas  .  .  .  she  went  to  his  home  in  the 
evening,  taking  with  her  some  toys  for  the  children,  more 
or  less  as  a  pretext  for  her  visit.  She  met  the  man  on  the 
stairs  coming  from  his  house  with  a  beer  can  in  his  hand, 
and  forthwith  sat  down  with  him  on  the  stairs  and  argued 
it  out  with  him  for  an  hour.  At  the  end  of  this  time  he 
returned  to  his  rooms,  the  impulse  to  drink,  for  the  time 
being  at  least,  conquered.  The  supervisor  sent  for  the 
record  and  found  the  incident  set  forth  in  it  as  follows: 

"Dec.  24,  '15.  Called  at  -  — .  Gave  man,  who 
was  at  the  door,  Christmas  stockings  and  other  toys  for 
the  children.  Man  had  not  been  working  this  week  but 
expects  employment  next  week  and  will  report  at  the 
district  office  on  Tuesday  night." 

This  is  omitting  the  process  with  a  vengeance. 
As  the  supervisor  rightly  felt,  what  the  visitor 
89 


THE  SOCIAL  CASE  HISTORY 

left  unrecorded  was  a  highly  significant  incident. 
Significance  here  lies  in  the  fact  that  this  drinking 
man  responded  to  appeal,  and  also  in  the  sort  of 
appeal  which  touched  him.  As  an  index  to  his 
character  it  matters  for  future  dealings  with  him 
to  know  through  which  of  his  social  relationships 
it  was  that  the  visitor  reached  him — whether 
through  his  love  for  his  family,  his  pride  in  his 
children,  his  self-love  and  sense  of  importance 
among  his  fellows,  his  religion;  or  through  self- 
interest — his  success  in  his  work  and  chances  of 
increased  pay. 

Another  instance  of  leaving  out  the  process  is 
that  of  a  worker  who  had  for  a  client  a  garrulous, 
meddlesome,  exacting  old  lady  with  relatives 
thoroughly  tired  of  her.  The  worker  evidently 
handled  her  with  tact  and  transformed  her  pes- 
tiferousness,  apparently  offhand,  into  an  acquies- 
cent meekness  which  her  family  could  hardly 
recognize.  As  in  the  former  case,  the  arguments 
or  the  method  of  handling  that  influenced  this 
woman  would  be  of  value  to  any  new  worker  who 
might  have  to  take  over  the  supervision  of  such 
a  client. 

90 


COMPOSITION  OF  THE  NARRATIVE 

On  the  other  hand,  the  following  passage 
records  a  procedure  in  treatment  that  seems  of 
doubtful  use  for  future  dealings  with  the  client: 

May  21,  '09.  P.  H.  visited  and  had  a  long  talk  with 
girl.  In  view  of  the  fact  that  girl  had  told  Miss  M.  that 
she  felt  she  could  never.keep  straight  out  in  the  commu- 
nity, P.  H.  asked  her  if  she  would  not  at  this  time  con- 
sider her  future  very  seriously,  and  see  if  perhaps  it 
would  not  be  better  for  her  to  give  up  all  idea  of  taking  a 
place  in  the  community  and  just  live  a  life  of  seclusion; 
said  that  she  felt  that  girl's  clergyman  in  Y.  would  know 
of  some  sisterhood  who  could  help  find  the  right  place  for 
her.  Girl  refused,  and  so  on. 

This  is  a  fairly  detailed  repetition  of  the  sub- 
stance of  the  visitor's  argument,  an  incident  in 
her  process  of  treatment.  Just  as  was  the  con- 
versation of  the  visitor  with  the  drinking  man, 
this  too  is  a  plea  for  a  desired  line  of  conduct. 
Yet  probably  any  experienced  worker,  including 
very  likely  the  visitor  herself  who  dictated  the 
interview,  would  agree  that  the  whole  statement 
could  be  adequately  expressed  in  the  sentence 

May  21,  '09.  P.  H.  visited  girl  and  urged  that  she  go 
into  life  of  seclusion.  Girl  refused,  and  so  on. 

Where  lies  the  difference  between  what  we 
91 


THE  SOCIAL  CASE  HISTORY 

advise  in  this  and  in  the  previous  illustration? 
The  girl's  belief  that  she  could  not  keep  straight 
together  with  a  physician's  opinion  to  the  same 
effect  had  already  been  recorded.  The  plea  the 
visitor  made  involves  no  discriminating  insight 
into  the  character  of  this  girl,  no  happy  intuition 
as  to  some  special  kind  of  appeal  that  would 
reach  her.  It  is  merely  a  direct  and  earnest  sug- 
gestion that  this  weak  client  should  do  an  ex- 
tremely high-minded  thing.  Had  she  yielded  to 
this  pleading,  the  whole  conversation  as  it  stands 
would  have  been  significant,  for  it  would  indicate 
an  unusually  suggestible  young  woman  or  else 
one  with  aspirations  remarkably  unsoiled  by 
repeated  sin.  Since  the  girl's  response  was  ex- 
actly what  one  would  ordinarily  expect  it  to  be, 
the  plea  put  up  to  her  by  the  worker  cannot  affect 
future  treatment. 

We  cannot  then  cut  out  all  processes  in  treat- 
ment mechanically  and  think  thus  to  improve 
our  records.  Here,  as  in  all  choice  of  facts  to  be 
entered  or  discarded,  we  have  constantly  to  ask 
ourselves,  "Is  this  process  of  relative  importance 


92 


COMPOSITION  OF  THE  NARRATIVE 

for  treatment  or  has  it  only  a  slight  or  a  tem- 
porary bearing,  and  why?" 

The  matters  of  ephemeral  interest  thus  far 
discussed,  then,  should  go  into  a  note-book,  on  a 
calendar  or  tickler,  or  into  a  day-book.  It  is  im- 
portant for  a  short  time.  The  day-book  is  de- 
signed to  enable  the  visitor  to  record  the  number 
of  visits,  telephone  calls,  interviews  in  the  office, 
etc.,  which  she  has  made  during  the  day,  and 
should  relieve  her  of  all  obligation  to  interrupt 
her  narrative  with  this  dry  data.  By  means  of  a 
calendar,  or  preferably  a  tickler,*  the  worker  can 


*  In  a  number  of  instances  agencies  feel  that  they  must 
preserve  permanently  both  "behold-me-busy"  and  proc- 
ess details.  This  is  because  of  three  uses  to  which  such 
items  are  put  from  time  to  time.  These  entries  may  fa- 
cilitate the  supervision  of  a  large  staff  of  visitors  by  showing 
just  what  motions  each  visitor  has  been  going  through 
from  day  to  day;  they  may  supply  evidence  to  critics  that 
the  agency  has  been  making  every  possible  effort  to  care  for 
clients  promptly;  or  in  case  of  illness  or  absence  of  any 
visitor,  they  may  keep  the  office  informed  of  her  plans  for 
clients,  her  appointments  with  them,  and  so  on.  When 
agencies  for  these  or  other  reasons  desire  to  keep  such 
details  they  can  do  this  and  at  the  same  time  make  their 
histories  clear  and  readable  by  recording  these  mechanical 
items  either  in  a  day-book  or  on  a  separate  record  sheet. 

93 


THE  SOCIAL  CASE  HISTORY 

rid  her  narrative  of  all  promises  to  call,  arrange- 
ments to  take  a  patient  to  a  hospital,  and  so  on. 
This  should  do  much  to  clear  records  of  matter 
that  interrupts  the  story  of  the  development  of 
treatment.  The  objection  to  unnecessary  entries 
of  the  kind  indicated  is  that  they  clutter  up  the 
important  parts  of  the  narrative.  The  reader's 
attention  is  constantly  distracted  from  the  main 
issues  by  sentences  or  lines  which  ceased  to  be  of 
moment  a  day  or  two  after  they  were  set  down. 
The  effect  of  such  transient  items  upon  the 
worker  also  is  to  confirm  her  in  an  unselective 
habit  of  mind  that  rises  to  no  mastering  of  the 
case  as  a  whole. 

Letters. — A  considerable  amount  of  ephemeral 
matter  is  to  be  found  also  among  the  letters 
which  social  agencies  send  and  receive  regarding 
their  clients.  These  letters  may  be  clipped  in 
with  the  history  at  the  places  where  they  belong, 
or  they  may  be  fastened  all  together,  separate 
from  the  rest  of  the  record.  In  either  case  they 
add  to  the  bulk  of  matter  in  a  filing  case,  and  in- 
crease by  just  so  much  the  number  of  sheets  to  be 
turned  over  and  looked  through.  For  this  reason 
94 


COMPOSITION  OF  THE  NARRATIVE 

letters  should  not  be  kept  longer  than  they  are 
useful. 

The  destruction  of  letters  is  something  agen- 
cies are  naturally  cautious  about.  In  many  in- 
stances a  carbon  copy  is  their  evidence  that  they 
have  reported  a  situation  promptly,  or  that  they 
have  shown  a  readiness  to  work  with  other  people, 
and  so  on.  As  for  the  letters  they  receive  from 
others,  probably  most  of  them  ought  to  be  kept 
at  any  rate  for  a  time.  Allowing  for  all  this,  how- 
ever, it  yet  remains  true  that  to  many  workers 
the  destruction  of  any  letter  or  carbon  copy  of  a 
letter  carries  forebodings  of  future  regret  analo- 
gous to  those  of  the  hoarder  of  broken-nosed  tea-  . 
pots  or  rungless  chairs. 

What  sort  of  letters  can  be  safely  destroyed? 
Principally  those  of  arrangement  or  those  which 
have  only  a  temporary  value.  Letters  of  arrange- 
ment, asking  that  a  client  be  at  the  station  at  a 
given  time,  sending  directions  for  getting  to  a 
new  address,  notifying  a  mother  that  she  should 
take  a  child  to  the  hospital  on  a  certain  day,  as- 
suring someone  who  referred  a  case  of  need  that 
the  client  had  been  visited  and  that  a  later  report 
95 


THE  SOCIAL  CASE  HISTORY 

would  go  to  him,  might  need  to  be  kept  for  a 
short  time  until  the  treatment  arranged  for  was 
completed,  but  could  then  certainly  be  destroyed. 
A  letter  containing  no  information,  merely  a  few 
polite  words  accompanying  an  enclosure — a  letter 
from  someone  else,  say — could  be  destroyed  at 
once.  Also  a  post-card  like  the  following: 


Dear  Miss 

Mrs.  Wilson  is  my  friend's  name  and  her  aunt's  address 
is  390  School  Street,  as  I  thought. 

Sincerely  yours, 

Once  the  information  has  been  transferred  to 
the  face  card,  what  further  use  can  the  post-card 
serve?  Probably  more  difference  of  opinion 
would  arise  over  notes  like  one  from  a  visitor  to 
a  young  girl  urging  her  to  take  a  good  place  that 
offered.  If  it  was  merely  a  pleasant  friendly  letter 
to  a  difficult  girl,  showing  no  special  insight  that 
would  afford  a  cue  to  the  effective  approaches  to 
be  made  in  her  case,  the  present  writer  would  be 
inclined  to  destroy  it,  making  note  on  the  record 
of  the  advice  sent.  She  would  also  reduce  the 
number  of  client's  letters  saved.  When  a  client 
is  a  lively  correspondent,  especially  if,  as  is 
96 


COMPOSITION  OF  THE  NARRATIVE 

sometimes  the  case,  he  has  the  post-card  habit,* 
two  or  three  communications  saved  to  show  his 
way  of  expressing  himself  and  the  sort  of  things 
he  was  thinking  about  ought  to  serve  all  pur- 
poses. 

Some  of  the  letters  of  arrangement  which  are 
evidently  of  but  passing  import  can  be  carboned 
on  colored  paper  and  thus  marked  for  ready  de- 
struction after  a  time.  The  answers  to  these 
letters  or  the  fact  of  arrangements  made  is  suffi- 
cient evidence  of  their  having  been  written. 

Of  the  letters  received,  all  containing  social 
evidence  bearing  on  the  client's  difficulties  should 
of  course  be  kept.  Where  the  office  force  is  suffi- 
cient to  permit,  these  should  be  briefly  summar- 
ized in  the  narrative  in  order  to  save  the  reader's 
time  and  also  the  break  in  his  attention  that  goes 
with  constant  turning  to  correspondence.  -  The 
worker  may  show  the  quality  of  her  judgment  as 
to  important  facts  in  her  choice  of  the  letters  to 
summarize.  Consider,  for  example,  the  two  fol- 

*  Social  workers  all  know  the  awkward  bunch  which  a 
number  of  post-cards  make  in  a  folder,  and  the  difficulty 
of  reading  them  when  clipped  together. 

7  97 


THE  SOCIAL  CASE  HISTORY 

lowing  entries  taken  from  the  same  record  of  a 
child  welfare  agency: 

Feb.  10,  '07.  Letter  from  Mother.  Says  [she  thinks]* 
she  would  like  to  bring  boy  to  Pottsville  herself;  that  she 
is  to  go  to  Ferguson  anyway  [and  if  boy  was  ready  could 
take  him  back.  Says  Miss  Frank  has  been  very  sick  for 
about  a  fortnight;  that  she  is  still  weak;  that  she  had 
congestion  of  the  blood  in  the  heart,  but  is  gaining  rap- 
idly. Mo.  says]  she  has  had  [a  great  deal  of]  trouble  with 
her  right  foot  [and  that  it  still  pains  a  great  deal;  that 
she  had  a]  doctor  treating  it  [but  he]  did  not  know  just 
what  the  trouble  was;  it  was  badly  inflamed.  [Says]  she 
is  in  her  own  room  at  last  and  likes  it  [very  much;  that] 
it  has  been  repapered  and  [that]  she  bought  the  paper  for 
it  [when  she  was  in  Ferguson;  that]  she  has  sheets  and 
blankets  and  pillow  slips  for  boy.  "As  there  is  again  no 
heat  in  my  room  I  shall  probably  have  to  buy  an  oil 
stove.  [I  dislike  it  on  account  of  the  odor,  but  there  are 
snappy  days  even  in  summer  and  I  must  be  ready  for 
them,  but]  when  winter  comes  I  shall  have  to  make  some 
change  to  avoid  further  sickness  for  baby."  [Says  the 
week  before  they  celebrated  Julia's  (mistress' daughter's), 
birthday.] 

As  contrasted  with  this  over-full  paraphrase  is 
the  curt  entry  made  a  few  months  later: 
July  3,  '07.    Letter  from  Dr.  Smith. 

*  Bracketed  passages,  in  the  writer's  opinion,  might  well 
be  omitted. 


COMPOSITION  OF  THE  NARRATIVE 

The  letter  from  Dr.  Smith  gives  the  physician's 
diagnosis  of  this  mother's  mental  condition  with 
his  opinion  as  to  the  possible  outcome.  The  letter 
itself  is  short  and  crucial.  Throwing  light,  as  the 
opinion  does,  on  the  whole  conception  of  the 
mother's  character,  all  the  succeeding  treatment 
must  take  it  into  account.  It  may  be  that  the 
worker  was  hurried  in  the  latter  instance,  or  it 
may  be  that  she  wished  to  oblige  the  reader  to 
turn  to  the  physician's  letter  itself.  This,  how- 
ever, being  compact  and  hardly  a  third  as  long  as 
the  previous  letter,  might  well  have  been  re- 
corded in  full.  The  two  entries  together  are 
merely  another  illustration  of  how  constantly  the 
worker's  eye  must  be  kept  "on  the  ball " ;  namely, 
on  the  treatment  value  of  every  fact  that  comes 
to  her. 

When  a  letter  is  followed  shortly  by  an  inter- 
view with  the  person  sending  the  letter,  space  can 
be  saved  and  reading  made  easier  by  incorpor- 
ating the  two.  If  the  letter  is  summarized,  the 
interview,  introduced  by  a  parenthetical  phrase 
("By  later  interview  with  the  same"),  should 
contain  only  information  not  already  given. 
99 


THE  SOCIAL  CASE  HISTORY 

Topical  vs.  Chronological  Organization. — In  com- 
posing the  current  history  as  a  whole  there  are 
two  general  methods  which  may  be  followed — 
the  chronological  and  the  topical.  The  chrono- 
logical is  the  recording  of  interviews  with  client, 
relatives,  doctor,  and  others,  one  after  another  as 
they  occur  in  point  of  time;  the  topical  is  the 
arrangement  of  matter  learned  in  a  number  of 
interviews  under  such  headings  as  environment, 
health,  finances,  employment,  and  so  on,  regard- 
less of  the  date  when  the  information  was  ac- 
quired. Each  method  has  advantages  and  draw- 
backs. 

The  chronological  method,  the  one  employed 
by  most  social  agencies,  is  convenient  because 
each  fact  or  happening  in  the  client's  life  can  be 
recorded  at  once  and  thrown  off  of  the  worker's 
mind.  Its  principal  recommendations  are  first 
that  it  makes  important  steps  in  the  process  of 
case  work  appear  in  sequence.  For  review  or 
self-criticism,  and  for  use  in  study  this  matters. 
We  must  be  able  to  go  over  in  detail  the  process 
of  treating  a  client's  need,  and  the  success  which 
these  measures  have  met  with.  Standards  in 
100 


COMPOSITION  OF  THE  NARRATIVE 

social  case  work  must  be  based  on  tire' results  of 
this  or  that  course  of  treatment.  Therefore  we 
need  to  have  recorded  all  the  important  steps  in 
the  process  as  they  occur  from  day  to  day.  The 
second  advantage  of  the  chronological  method  is 
that  it  keeps  together  the  whole  statement  of  any 
person  interviewed,  thus  giving  a  total  impres- 
sion of  his  reliability  or  bias  as  a  witness,  of  his 
attitude  toward  the  client,  and  of  his  possible 
helpfulness  in  adjusting  the  latter's  difficulties. 
One  can  see  in  the  following  illustrations  the  con- 
tr.ist  between  the  definiteness  as  to  the  single 
impression  of  a  devoted  and  anxious  aunt  pro- 
duced by  this  chronological  record,  and  the 
definiteness  as  to  the  general  social  factors  in  the 
case  produced  by  the  topical  method. 

CHRONOLOGICAL 

Aug.  6,  '10.  Visitor  at  house.  Mother  says  father 
knocked  down  by  auto  six  months  ago.  Works  irregu- 
larly on  account  of  accident  which  still  affects  his  leg. 
Has  to  be  careful  not  to  use  it  too  much.  Mother  says 
he  averaged  $6  to  $7  per  week.  She  tried  to  do  office 
cleaning,  but  found  was  needed  at  home  and  gave  it  up. 
Three  months'  rent  is  due,  $42.0x3;  grocer's  bill  $8.50. 
Maternal  grandfather  dead,  grandmother  in  Italy  with 

101 


THE  SOCIAL  CASE  HISTORY 

Uncle 'John  Risolli  who  has  wife  and  three  children. 
Paternal  uncle  has  six  children,  earns  barely  enough  for 
his  own  family. 

Aug.  6,  '10.  Dr.  F.  of  St.  Luke's  out-patient  depart- 
ment says  man's  leg  was  run  over,  he  was  much  shaken 
up.  Was  in  St.  Luke's  Hospital  three  months;  still  at- 
tends out-patient  department.  John  not  vigorous,  needs 
general  building  up. 

Aug.  7,  '10.  Aunt  Antonia  at  office  by  appointment; 
short,  slender,  slow  of  speech  and  motion;  uses  fairly 
good  English;  poorly  dressed,  not  clean.  Says  she  is 
working  part  time  on  account  of  strike;  has  not  been 
able  to  earn  more  than  $10  a  week  at  $2.00  a  day.  Would 
be  glad  to  help  with  expense  of  Joseph,  but  feels  that  the 
mother,  her  sister,  needs  all  that  she  can  spare  from  her 
earnings;  she  is  quite  troubled  because  family  does  not 
have  sufficient  nourishment,  particularly  as  father  is  not 
well  and  John  is  inclined  to  be  delicate.  Aunt  promises 
if  at  any  time  she  is  in  better  circumstances  to  help  wit  h 
clothes  for  Joseph. 

Aug.  7,  '10.  Charity  Organization  Society  report: 
.  .  .  man's  parents  both  dead,  never  in  U.  S.  Brother 
Peter  Capri  living  at  205  Maple  St.,  married.  Respect- 
able and  hard-working. 

TOPICAL 

Relatives  Paternal  relatives.  Grandparents  both  dead; 
never  in  U.  S.  Uncle  Peter  Capri,  living  at  205  Maple 
St.,  married,  six  children.  Respectable  and  hard- 
working. Earns  barely  enough  for  his  own  family. 

102 


COMPOSITION  OF  THE  NARRATIVE 

Maternal  relatives.  Grandfather  dead,  grand- 
mother in  Italy  with  uncle  John  Risolli,  who  has  wife 
and  three  children.  Aunt  Antonia  Risolli  lives  with 
family,  short,  slender,  slow  of  speech  and  motion;  uses 
fairly  good  English;  poorly  dressed,  not  clean.  Helps 
all  she  can. 

Employment  Father  works  irregularly  on  account  of 
accident  which  still  affects  his  leg.  Says  averaged 
$6.00  to  $7.00  per  week.  Mother  tried  to  do  office 
cleaning,  but  found  was  needed  at  home  and  gave  it  up. 
Aunt  Antonia  is  working  part  time  on  account  of 
strike,  has  not  been  able  to  earn  more  than  $10  a  week 
at  $2.00  a  day. 

Health  Father  knocked  down  by  auto  six  months  ago. 
Much  shaken,  leg  run  over.  In  St.  Luke's  hospital  3 
months,  still  attends  out-patient  department.  Has  to 
be  careful  not  to  use  leg  too  much.  John  not  vigorous. 
Dr.  F.,  of  St.  Luke's  out-patient  department,  says 
needs  general  building  up.  Aunt  Antonia  quite 
troubled  because  she  recognizes  that  family  does  not 
have  sufficient  nourishment,  particularly  as  father  is 
not  well  and  John  inclined  to  be  delicate. 

Finances  Three  months'  rent  due,  $42.00;  grocer's  bill, 
$8.50.  Aunt  Antonia  would  be  glad  to  help  with  ex- 
pense of  Joseph  but  feels  that  the  mother,  her  sister, 
needs  all  that  she  can  spare  from  her  earnings. 

The  facts  in  the  interview  as  first  recorded,  after 

being  scattered  and  combined  with  facts  gathered 

from  other  interviews,  lose  perhaps  something  of 

103 


THE  SOCIAL  CASE  HISTORY 

their  force  as  pointing  in  a  general  way  to  the 
character  of  an  important  relative,  while  by  the 
same  analyzing  process  they  gain  in  the  impres- 
sion they  produce  of  bearing  upon  the  family 
situation  as  to  employment,  health,  finances. 
The  difference  between  the  two  methods  is  partly 
a  choice  as  to  what  sort  of  impression  the  worker 
wishes  to  make  upon  the  reader,  what  aspect 
she  wishes  to  emphasize.  The  present  writer 
confesses  to  some  scepticism  as  to  how  much 
is  gained  in  clear  impression  of  character  merely 
by  keeping  the  average  interview  intact.  What- 
ever shows  specific  qualities  in  the  talk  of  a 
relative  or  employer  can  be  given  its  due  weight 
under  a  heading,  as  can  be  also  any  impressions 
of  the  visitor's.  Impressions  too  subtle  to  be  put 
into  words  are  worthless  for  treatment. 

The  drawbacks  attendant  upon  the  chronolog- 
ical method  are  that,  compared  with  the  topical, 
it  makes  for  a  succession  of  relatively  short  en- 
tries, in  which  the  expected  rhetorical  consecu- 
tiveness  is  lost,  and  which,  bearing  possibly  upon 
different  aspects  of  the  client's  situation,  have 


104 


COMPOSITION  OF  THE  NARRATIVE 

not  a  close  connection  in  ideas.    Witness  these 
entries  from  a  history  in  a  family  agency: 

Dec.  20,  '16.  Mrs.  M.  to  office.  Will  begin  training 
at  the  hospital  on  Jan.  ist.  Is  anxious  about  little 
Marshall,  who  has  taken  cold. 

Dec.  27,  '16.  Letter  from  Miss  I.  enclosing  check  for 
$75  toward  Marshall's  board. 

Dec.  28,  '16.  Miss  F.,  Child  Welfare  Board,  tele- 
phones. Placed  Marshall  in  home  of  Mrs.  Parker,  Farm- 
ville.  His  mother  can  visit  him,  as  it  is  within  10  cent 
car  ride.  His  cold  has  disappeared. 

Dec.  29,  '16.  Letter  from  Mrs.  M.  asking  money 
promised  for  storage  of  her  furniture.  The  two  girls  are 
happy  at  aunt's.  Expresses  contentment  with  arrange- 
ments. Visitor  sent  check  for  $5. 

Dec.  30,  '16.  Sent  Mrs.  M.  a  good  second-hand  skirt 
which  she  needed  badly. 

Although  all  these  statements  bear  on  a  defi- 
nite plan  of  treatment;  namely,  one  providing 
training  for  a  mother  and  care  for  her  children 
meanwhile,  not  only  does  each  entry  touch  upon 
some  different  one  of  the  many  aspects  of  this 
plan,  but  it  tells  very  little  about  that  aspect. 
The  result  is  a  scrappy  succession  of  partially  re- 
lated facts.  Moreover,  often  as  the  thread  of 
interest  may  be  broken,  one  must  carry  in  mem- 
105 


THE  SOCIAL  CASE  HISTORY 

ory  all  important  items  from  beginning  to  end  of 
the  record.  This  is  because  it  may  be  necessary 
in  order  to  get  at  the  reasons  for  the  mother's 
receiving  a  chance  for  training,  or  for  the  chil- 
dren's being  placed  two  with  an  aunt  and  one  at 
board,  to  piece  together  as  we  read  two  or  three 
items  or  interviews  on  page  I  of  the  narrative, 
scattered  ones  on  pages  2,  3,  4. 

Another  difficulty  with  chronological  recording 
is  that  the  worker  is  more  likely  to  be  careless 
about  introducing  irrelevant  matter  when  she 
dictates  without  headings  to  force  her  to  analyze 
the  information  she  has  gathered.  She  tends  in 
her  hurry  to  report  a  conversation  much  as  it  has 
come  to  her.  It  takes  some  thought  to  pick  out 
of  an  hour's  detailed  talk  with  the  mother  of  a 
family,  which  nevertheless  in  its  total  outcome 
has  been  an  important  one,  just  which  were  the 
statements  that  pointed  to  those  social  concep- 
tions which  would  bear  upon  later  treatment. 
The  absence  in  chronological  recording  of  any 
mechanical  stimulus  toward  choosing  significant 
items,  and  the  lack  of  coherence  between  entries 
together  make  the  current  history  deficient  in 
1 06 


COMPOSITION  OF  THE  NARRATIVE 

"unity."  Such  a  narrative  does  not  excite  spon- 
taneous attention;  the  average  case  record  de- 
mands a  fresh  mind  with  untired  powers  of  con- 
centration if  the  reader  is  to  get  a  clear  connected 
story  with  its  pertinent  items  in  the  foreground. 
The  topical  method  of  recording  is  in  its  ad- 
vantages and  drawbacks  the  obverse  of  the  chron- 
ological. It  is  never  used  to  the  exclusion  of  the 
chronological,  always  in  combination  with  it,  and 
is  usually  confined  to  the  first  investigation.  The 
Massachusetts  State  Board  of  Charity,  for  in- 
stance, in  its  Mother's  Aid  records^  has  the  first 
investigation  written  up  under  the  captions 
Finances,  Employment,  Health,  Education, 
Home  Standards,  and  so  on.  This  enables  the 
supervisor  to  judge  rapidly  whether  visitors  have 
covered  the  ground.  One  blanket  caption  called 
Remarks  catches  all  stray  information.  Inexperi- 
enced visitors  sometimes  repeat  here  in  different 
words  much  that  they  have  already  included 
under  one  or  another  specific  heading.  They 
imagine  themselves  to  be  giving  additional  facts, 
probably  because  they  have  had  to  talk  at  length 
with  several  people,  and  bring  back  from  these 
107 


THE  SOCIAL  CASE  HISTORY 

interviews  a  vague  assurance  of  having  learned 
more  than  it  shows  up  for  under  the  forced  anal- 
ysis of  captions.  The  rest  of  the  record,  that 
which  reports  treatment,  is  put  down  chronolog- 
ically. 

Another  public  department*  has  the  investiga- 
tion recorded  by  separate  interviews  first,  and 
then  on  all  cases  with  which  intensive  social  work 
is  to  be  done  has  a  topical  history  in  addition. 
This  last  history  is,  then,  in  reality  a  full  and 
analyzed  summary.  If  not  actually  itself  an  in- 
terpretation of  the  case,  it  would  represent  the 
steps  which  must  precede  interpretation. 

The  advantages  of  the  topical  method  are, 
first,  that  it  develops  each  topic  by  a  paragraph 
of  which  the  purport  is  readily  gathered,  since  it 
marshals  all  the  testimony  that  makes  clear  one 
of  the  large  social  relationships  that  orient  the 
client's  case.  One's  attention  is  therefore  held 
without  effort.  Second,  it  guides  the  worker  to 
the  facts  of  real  moment  in  the  case  by  holding 
before  her  certain  of  the  broad  social  relations 
which  give  meaning  to  this  or  that  fact. 

*  The  Boston  Psychopathic  Hospital  Social  Service. 
108 


COMPOSITION  OF  THE  NARRATIVE 

The  limitations  of  the  topical  history  have  been 
sufficiently  indicated  in  the  discussion  of  the  ad- 
vantages of  the  chronological.  They  are  in  brief 
(i)  that  it  effaces  the  process,  whether  of  investi- 
gation or  treatment,  and  (2)  that  it  discards  the 
interview  as  an  integral  statement  that  may 
afford  an  indirect  characterization  of  the  person 
interviewed.  Another  objection  that  might  be 
made  is  that  this  method  effaces  the  identity  of 
the  person  giving  information  and  with  it  the 
evidence  as  to  the  degree  of  reliability  to  be 
placed  on  his  testimony.  In  any  arrangement  of 
narrative  matter  by  topics,  however,  the  name  of 
the  man  or  woman  responsible  for  a  statement 
together  with  any  facts  or  remarks  as  to  his  value 
as  a  witness  may  be  put  in  parentheses  either 
before  or  after  this  statement:  for  example, 
"(according  to  woman's  sister,  who  impressed 
visitor  as  withholding  important  information)." 

We  have  heretofore  been  discussing  the  topical 
history  as  an  analysis  of  the  whole  first  investiga- 
tion. The  analysis  of  subject  matter  under  topics, 
however,  can  be  made  within  any  long  interview 
without  sacrificing  the  advantages  of  keeping 
109 


THE  SOCIAL  CASE  HISTORY 

each  conversation  intact  under  its  own  date. 
Take  the  following  analysis  of  a  first  interview 
with  the  mother  of  a  family  by  a  child-placing 
agency  that  has  been  asked  to  board  a  delicate 
girl  in  the  country: 

Environment*  (J.  B.)  Called  at  home.  Rear  tenement; 
small  yard,  entrance  narrow  alley-way,  paper  and  re- 
fuse about;  4  rooms,  2nd  flight;  furniture  scanty, 
good  stove. 

Family  Consists  of  mother  (widow)  and  3  children, 
living  together.  Mother  35  yrs.  old,  born  and  grew  up 
in  Ralston  as  did  also  father.  He  worked  in  paper  mill 
most  of  life  till  health  failed  3  years  ago.  They  moved 
to  F.  hoping  he  could  make  more  at  canvassing.  Tall, 
wiry,  nervous  American  woman;  fairly  clean  dress. 
Complains  much  about  neighborhood  and  about  de- 
privations, which  are  great.  Remembers  with  longing 
better  days  in  past.  Fears  for  the  girl's  health  and  the 
boys'  chances  of  education. 

Colton  13  yrs.  old,  intelligent  looking  boy;  wants  to  be 
a  carpenter;  handy  with  tools. 

Bessie  n  years  old,  mentally  bright,  does  beautiful 
sewing,  took  prize  at  school. 

George    8  yrs.  old,  average  mental  development;    has 

*  The  italicized  captions  are  here  fully  entered  for  the 
sake  of  clearness.  For  shorter  interviews,  however,  a 
regular  topical  order  in  the  paragraphing  is  sufficient,  and 
captions  may  be  dispensed  with. 

110 


COMPOSITION  OF  THE  NARRATIVE 

not  outgrown  childish  interests;  plays  with  children 
younger  than  himself. 

Education  Mother  went  through  Grammar  School. 
Colton  finishes  Grammar  School  in  spring.  Bessie 
attends  Prince  School,  6th  grade.  George  attends 
Abraham  Lincoln  School,  2nd  grade. 

Religion  Episcopalian,  members  of  church.  Children 
go  to  Sunday  school  at  Grace  Church;  mother  goes 
when  has  clothes.  Does  not  like  to  keep  asking 
ladies  at  church  for  garments. 

Financial  Father  had  made  bare  living  for  3  years  be- 
fore death  as  canvasser  for  "Book  of  Knowledge." 
Left  $500  insurance.  Funeral  cost  $240.  Mother  has 
eked  out  remainder  for  living  expenses;  all  gone  now. 
Oldest  boy  gets  abt.  $1.00  a  week  selling  papers. 
Mo.  has  two  places  to  wash  at  $2  a  day.  Would  like 
more.  Uncle  Fred  sends  $5  occasionally.  His  help 
can't  be  counted  on,  as  he  has  heavy  expenses. 

Health  Father  died  6  mos.  ago  of  tuberculosis  at  hos- 
pital. Was  there  3  months.  Poor  health  for  3  to  4 
years  previously.  Did  canvassing  at  doctor's  advice  to 
be  out  of  doors.  Mother  very  thin,  looks  well  other- 
wise and  says  she  is  so.  Colton,  thin,  apparently 
well.  Bessie,  undersized,  pale,  looks  delicate.  George 
also  is  undersized.  Mother  thinks  all  children  under- 
nourished. 

Relatives  Paternal  grandparents  died  in  Ralston; 
grandmother  at  70  years  of  tuberculosis;  grandfather 
at  50  yrs.  of  heart  disease.  Uncle  William  and  wife 
Jane,  5  children,  live  in  Canada.  Family  has  not 

III 


THE  SOCIAL  CASE  HISTORY 

heard  from  them  for  years.  Maternal  grandparents 
Frank  and  Carrie  Colton.  Grandmother  died  of  cancer 
at  60  yrs.  Grandfather  living  in  Ralston  with  Uncle 
Frederick,  married,  4  children.  He  works  in  a  coal 
office,  has  helped  mother  from  time  to  time. 

It  will  be  seen  that  nothing  is  lost  here  so  far  as 
the  impression  conveyed  of  the  character  of  the 
various  members  of  the  family  is  concerned. 
Indeed,  one  gets  a  clearer  indication  of  character 
than  from  interviews  which  are  not  analyzed. 
As  the  record  stands,  however,  the  reader  hesi- 
tates to  weigh  the  value  of  this  evidence  as  such. 
We  seem  to  get  not  what  this  overanxious  mother 
says  about  the  situation  but  statements  of  ac- 
cepted fact:  George  plays  with  children  younger 
than  himself;  Colton  is  handy  with  tools;  the 
mother  went  through  the  grammar  school.  It  all 
suggests  that  possibly  the  interview  was  not 
written  up  until  after  further  investigation  had 
shown  the  mother's  reliability  as  a  witness,  or  it 
may  be  that  the  worker  assumed  that  the  reader 
would  take  the  whole  for  what  it  was  worth  as 
the  mother's  statement.  This  same  analyzed 
interview  could  be  made  more  "readable"  by  the 

112 


COMPOSITION  OF  THE  NARRATIVE 

addition  of  the  connective  words  used  in  ordinary 
writing.* 

Rhetoric  in  Record  Writing. —  Verbosity. — So- 
cial case  records,  like  all  writing,  must,  of  course, 
be  clear  as  to  their  purport.  A  special  requisite, 
however,  is  that  they  should  be  as  compact  as  is 
consistent  with  clearness.  Every  unnecessary 
expression  is  that  much  waste  of  time  on  the  part 
of  dictator,  stenographer,  supervisor,  and  stu- 
dent.f 

A  besetting  fault  of  the  writer — or  dictator — of 
social  case  records,  after  the  fault  of  admitting 
irrclevancies,  is  that  of  redundancy  in  expression. 
Take  up  at  random  almost  any  history  in  any 
office  and  on  a  single  page  one  will  find  words, 
phrases,  clauses,  whole  sentences  that  either 
repeat  the  thought  or  stretch  it  out  through  ten 
words  where  five  would  do.  This  is  nothing  that 
any  agency  should  feel  sensitive  about  acknowl- 

*See  p.  120. 

f  Inexperienced  workers  who  have  not  yet  fully  learned 
the  range  of  facts  needed  in  treating  clients,  and  who  con- 
sequently often  omit  significant  evidence  from  their  his- 
tories, need  to  be  warned  against  taking  this  advice  to 
mean  that  there  is  a  merit  in  mere  brevity  for  its  own  sake. 

8  113 


THE  SOCIAL  CASE  HISTORY 

edging.  It  is  common  to  all,  because  none  of  us 
has  had  special  training  in  dictation.  Take,  for 
example,  the  following  excerpt  in  which  the  re- 
dundancy is  comparatively  slight: 

May  20,  '10.  Visitor  talked  with  employer  who  says 
[Mrs.  S.  has  been  thoroughly  inefficient  and  unsatis- 
factory.] They  have  not  been  able  to  rely  upon  her 
either  in  keeping  her  hours,  or  the  correct  use  of  her  time, 
or  [satisfactory]  execution  of  her  duties.  She  has  asked 
[many]  favors,  and  seemed  to  think  that  she  was  abused 
when  not  granted  them.  She  is  a  [great]  gossip,  and  has 
created  a  spirit  of  complaint  among  the  employees  in  her 
section.  She  [is  also  constantly]  complaining  of  her 
health,  and  the  doctor  has  told  her  that  her  troubles  are 
largely  due  to  her  excessive  tea  drinking. 

The  passages  or  words  in  brackets  are  unneces- 
sary. If  an  employee  does  not  keep  to  hours,  use 
her  time  profitably,  or  execute  her  duties  she  is 
of  course  inefficient  and  unsatisfactory.  The 
more  explicit  statement  includes  the  general  one. 
If  she  gossiped  no  more  than  the  average,  this 
trait  would  not  have  been  commented  upon, 
therefore  the  word  "great"  adds  nothing.  The 
same  is  true  of  the  phrase  "she  is  always  com- 
plaining.'* Substitute  "she  complains."  Unless 


COMPOSITION  OF  THE  NARRATIVE 

she  did  more  complaining  than  others,  her  em- 
ployer would  not  have  noticed  it.  Small  redun- 
dancies of  this  kind  accumulating  through  a 
whole  record  interlard  the  essential  items  with 
impeding  layers  of  words. 

Take  an  illustration  from  a  child-placing 
agency. 

Sept.  6,  '09.  (F.  P.)  Vis.  foster  mo.,  M.  doing  [very] 
well  and  fo.  mo.  feels  [sure]  that  girl  is  trying  [very  hard] 
to  improve.  Fo.  mo. wrote  to  mo.  in  regard  to  M.  's  opening 
her  letter  and  mo.  [had  replied  telling]  authorized*  fo.  mo. 
to  punish  her  any  way  she  saw  fit.  Said  M.  had  given 
her  [a  great  deal  of]  sorrow  and  she  knew  that  the  girl 
needed  [severe]  discipline.  M.  entered  5th  grade,  is 
doing  excellent  work.  School  is  conducted  in  open  air 
[and  chn.  have  been  measured  to-day  for  some  sort  of 
warm  garment  to  be  worn  during  the  winter.  These] 
warm  garments  for  winter  are  to  be  provided  by  some 
society  in  X.  [fo.  mo.  did  noj;  know  the]  name  unknown. 
M.  is  now  taking  [a  great  deal  of]  pride  in  her  [personal] 
appearance,  keeps  herself  neat  and  clean  without  so  much 
prodding  from  fo.  mo.,  and  so  on. 

Again  we  see  the  unnecessary  and  therefore  inef- 
fective multiplication  of  words.  The  fact  that  the 

*  The  words  in  italics  are  substitute  expressions;  brack- 
eted words  are  superfluous. 

115 


THE  SOCIAL  CASE  HISTORY 

school  children  had  been  measured  for  garments 
is  of  too  trifling  relevancy  to  be  included.  In  the 
illustrations  on  pp.  80  and  98  also,  the  import 
of  the  sentences  and  phrases  excised  is  implied  in 
the  statements  retained  in  the  condensed  entries; 
and  it  would  be  more  vigorously  conveyed  by 
them  alone. 

In  these  illustrations  appears  frequently  the 
use  of  intensive  words,  like  very,  exceedingly,  ex- 
cessive, a  great  deal  of,  and  so  on.  In  case  histories 
they  give  an  emotional  tone  where  the  desired 
tone  is  a  judicial  one.  In  the  illustration  on  p.  1 14 
the  visitor  appears  to  have  shared  an  exaspera- 
tion that  the  employer  felt  toward  her  client.  It 
does  not  seem  professional,  however,  to  suggest 
this  exasperation  by  the  tone  of  one's  language 
instead  of  noting  it  responsibly  as  a  fact  in  the 
situation.  The  visitor  had  better  have  cut  out 
her  adjectives,  confined  herself  to  a  dispassionate 
report  of  the  actual  facts  the  employer  gave,  and 
then  under  the  heading  of  Impressions  have 
stated  that  the  employer  was  apparently  out  of 
patience  with  Mrs.  S.  and  that  she  herself  shared 
his  feeling. 

116 


COMPOSITION  OF  THE  NARRATIVE 

A  bbreviations. — Some  agencies  abbreviate  words 
to  save  time  and  space,  and  have  a  fairly  long  list 
of  habitual  abbreviations:  fa. — father,  fo. — foster, 
w. — with,  fr. — from,  g. — girl,  b. — boy,  and  so  on. 
Of  such  symbols  those  that  stand  for  the  re- 
current stock  terms  in  case  work  have  a  fair 
claim  to  be  standardized  among  all  agencies. 
Thus— 

fa. — father  vis. — visitor 

mo. — mother  fo. — foster 

dau. — daughter  D.  S. — district  secretary 

sr. — sister  rel. — relative 

bro. — brother  pro. — probation 

ch. — child  pa. — patient 

chn. — children  Fm. — feeble  minded 

worn. — woman   *Tb. — tuberculosis 

mat. — maternal 

pat. — paternal 

Such  symbols  as  w.  for  with,  b.  for  boy,  and  h.  for 
home,  however,  make  the  history  difficult  to  grasp 
except  by  those  who  are  familiar  with  these  ab- 
breviations by  constant  practice. 

Perspective  in  sentence. — Sentence  structure  in 
our  records  is  of  the  simplest  sort.  Often  even  the 
subject  of  sentences  is  omitted,  theword  "visitor" 
117 


THE  SOCIAL  CASE  HISTORY 

or  the  name  of  the  interviewed  person  being  as- 
sumed to  be  the  subject.  "Called  on  man.  Said 
he  was  feeling  better/'  instead  of  "The  visitor 
called  on  the  man.  He  said  he  was  feeling  bet- 
ter." This  elliptical  fashion  of  speech  is  employed 
because  one  or  the  other  of  these  two  persons  is 
so  likely  to  be  the  spokesman  for  what  follows 
that  it  can  be  assumed.  There  is  no  objection  to 
this  way  of  shortening  entries,  provided  the 
worker  makes  sure  that  she  uses  the  subject  name 
whenever  the  subject  changes.  For  instance,  in 
the  illustration  given  on  p.  80,  throughout  all 
the  first  part  of  the  interview  the  subject  of  the 
sentences  is  Harriet,  the  client.  Then  suddenly 
come  four  sentences : 

"Troubled  about  Harriet's  attitude  toward  death. 
Talked  with  her  at  length  about  it  when  her  mother  died 
and  H.  insisted  that  she  did  not  believe  there  was  any 
future  life.  Unable  to  change  her  feeling  in  the  matter. 
Has  spoken  to  clergyman,  Mr.  S.,  who  will  at  the  first 
opportunity  talk  the  matter  over  with  H." 

It  is  of  course  plain  that  Harriet  is  not  the  one 

who  makes  these  statements,  but  it  is  not  at  once 

clear  whether  it  is  the  foster  mother  or  the  visitor 

118 


COMPOSITION  OF  THE  NARRATIVE 

who  was  troubled  over  Harriet's  attitude  toward 
death.  As  one  reads  along  one  makes  out  that 
these  are  the  foster  mother's  comments.  What 
the  worker  did  in  dictating  was  to  repeat  the  talk 
of  the  foster  mother  as  it  took  place  without  stop- 
ping to  distinguish  what  the  foster  mother  said 
that  H.  had  felt  and  done  from  what  the  foster 
mother  herself  felt  and  did.  The  latter  remarks, 
therefore,  have  an  effect  of  coming  from  the  vis- 
itor. In  the  final  sentence  of  the  paragraph  we 
go  back  to  Harriet  as  the  subject. 

As  to  verbs,  the  only  warning  needed  is  that 
whether  the  worker  starts  her  record  in  the  past 
or  in  the  present  tense,  she  should  abide  by  her 
choice  throughout,  and  not  seesaw  from  one  to 
the  other,  as  in  the  following  instance: 

June  22,  '08.  M.  F.  called  at  7  o'clock.  Mrs.  X. 
sitting  in  kitchen  holding  Jane  whom  she  has  just  bathed. 
Mollie  who  is  8  years  old  (present  of  continuity,  therefore 
correct)  is  very  cleanly  dressed,  and  the  kitchen  in  ex- 
quisite order.  Mrs.  X.  is  very  cordial,  said  she  had 
sometimes  thought  of  coming  to  office,  but  did  not  like 
to  intrude.  Says  she  has  been  getting  on  very  nicely,  and 
still  has  $200  insurance.  She  moved  to  present  house 

119 


THE  SOCIAL  CASE  HISTORY 

where  the  rent  is  $2.50  per  week  (present  of  continuance). 
She  is  still  working  at  the  Carpet  Factory  (continuance). 

The  effect  is  confusing.  These  rapid  alterations 
of  the  time  point  of  view  make  against  clearness. 
In  their  desire  to  make  records  brief  many 
workers  have  adopted  a  telegraphic  omission  not 
only  of  the  subject  word  but  of  articles  and  aux- 
iliary verbs.  "Man  came  to  office"  instead  of 
"The  man  came  to  the  office."  "Mrs.  X.  sitting 
in  kitchen"  instead  of  "Mrs.  X.  is  (or  was)  sitting 
in  the  kitchen."  When  one  finds  this  abbrevia- 
tion of  style  combined  with  abbreviations  of 
words,  one  has  the  laconic  pushed  to  the  point 
of  grotesqueness. 

"  Met  mo.  w.  b.  at  hosp.    Vis.  admires  mo's.  devotion 
to  chn.    Dr.  says  b.  need  not  stay  ho.  longer  fr.  sch." 

The  curious  thing  is  that  these  mechanical  short- 
cuts are  sometimes  to  be  found  in  the  very  same 
records  and  in  the  very  same  interviews  where 
one  idea  is  spread  out  through  several  padded 
statements,  or  whole  sentences  of  slight  relevance 
may  take  up  as  much  space  as  a  succession  of 
these  devices  combined  can  save. 
120 


COMPOSITION  OF  THE  NARRATIVE 

The  planning  of  paragraphs  in  case  records 
should  be  according  to  the  common  rhetorical 
rule  of  making  each  paragraph  center  about  one 
main  idea  and  of  placing  that  main  idea  in  the 
most  conspicuous  position;  namely,  at  the  begin- 
ning or  end  of  the  paragraph.  This  topic  will  be 
discussed  in  Chapter  V  in  connection  with  the 
investigation  and  the  treatment  record. 

There  are  a  number  of  manuscript  devices 
which  social  agencies  may  employ  in  their  records 
in  order  to  call  attention  to  the  important  facts. 
Such  devices  are  red  lettering,  underlining,  in- 
denting, marginal  captions,  brackets,  stars,  and 
so  on.  Their  use  makes  it  possible  to  run  through 
a  long  record  and  light  at  once  upon  those  items 
about  which  the  worker  is  most  likely  to  want  to 
remind  herself  in  the  course  of  her  treatment  of  a 
family  or  individual.  One  agency  underlines  the 
name  of  the  person  interviewed  in  red  letters. 
Another  underlines  the  person  interviewed  and 
uses  red  ink  for  topical  captions  which  are  put  in 
the  margin,  as  follows: 

April  6,  '12.  (F.  S.)  Mrs.  Alfred  Pearson,  Vernon  St. 
Whitman  [wife  of  leading  lawyer  in  town].  Has  known 

121 


THE  SOCIAL  CASE  HISTORY 

Jackson  family  since  mother  a  baby;  lived  opposite  them 
in  Bridge  water. 

Mat.  relatives.  Family  one  of  best  in  town.  Mater- 
nal grandfather  was  a  fireman  in  iron  works  for  many 
years,  chief  warden  in  the  Methodist  Church.  Grand- 
mother capable.  Maternal  aunts  Lucy  and  Mattie  fine 
girls,  and  so  on. 

The  brackets  above  enclose  information  about 
the  person  interviewed,  and  make  it  easy  to 
notice  or  skip  over  these  words  according  to  the 
reader's  need.  Of  course  all  information  about 
and  impressions  of  the  person  interviewed  can 
be  put  in  a  paragraph  by  themselves  at  the  end 
of  the  interview,  if  preferred. 

The  agency  from  which  the  illustration  on  p. 
no  was  taken  uses  indented  red  letter  captions 
to  indicate  the  broad  topics  in  their  recording, 
i.  e.,  Finances,  Employment,  Education,  Envi- 
ronment, Religion,  Relatives.  A  worker  of  long 
experience  indents  her  summaries  from  other 
agencies.  For  instance: 

Mrs.  F.  distressed  over  Peter's  conduct.  Does  her 
best  to  make  him  mind,  but  when  she  is  away  from  home 
he  runs  wild,  and  has  been  going  from  bad  to  worse. 

Feb.  2,  '04,  Visitor  telephoned  Charity  Organization 
122 


COMPOSITION  OF  THE  NARRATIVE 

Society,  who  report  family  known  first  in  1901.     Mr.  F. 
was  then  very  ill  with  tuberculosis,  and  so  on. 

Different  agencies  now  use  various  devices  ac- 
cording to  their  special  needs  or  ideas  of  conveni- 
ence. It  is  of  primary  importance  that  each 
agency  should  use  these  devices  consistently,  ap- 
plying underlines,  brackets,  red  letters,  inden- 
tion, etc.,  for  the  same  thing.  It  is  becoming  of 
hardly  secondary  importance  that  all  case  work 
agencies  should  agree  upon  a  standardization  of 
their  uses.  As  social  research  workers  come  in- 
creasingly to  extend  their  researches  through  the 
records  of  many  agencies,  they  have  a  claim  to 
be  relieved  from  the  waste  of  energy  that  is  in- 
volved in  mastering  a  fresh  code  with  each  agency 
they  consult.  The  present  writer  has  felt  that 
she  had  no  warrant  to  offer  a  code  of  her 
own  preference.  Standardization  when  it  comes 
should  be  the  work  of  a  responsible  committee. 


123 


V 

THE  NARRATIVE  IN  DETAIL 

'TpHE  narrative  comprises  (i)  reported  inter- 
views  with  theclient  and  with  those  acquainted 
with  him,  (2)  an  interpretation  of  his  case,  and 
(3)  a  chronological  record  of  what  the  agency 
does  with  and  for  him. 

The  Organization  of  Reported  Interviews. — Inter- 
view form. — In  general,  social  case  work  inter- 
views are  recorded  in  some  such  order  as  the  fol- 
lowing: 

1.  Date  of  the  interview. 

2.  Initials  or  name  of  the  visitor.  This  is  some- 
times entered  at  the  beginning  and  sometimes  at 
the  end  of  the  interview.  If  the  initials  are  at  the 
beginning,  the  reader  can  take  account  of  the  , 
personality  of  the  visitor,  giving  greater  weight 
to  the  observation  and  selection  of  facts  on  the 
part  of  an  experienced  worker. 

3.  Relation  of  the  person  interviewed  to  the 

124 


THE  NARRATIVE  IN  DETAIL 

family;  for    example,    "Man's    aunt,    woman's 
former  employer,  Mary's  teacher." 

4.  Name   and   address   of   the   person   inter- 
viewed.  This  follows  the  item  as  to  the  relation 
of  this  person  to  the  family,  since  it  is  the  less 
important  fact  of  the  two  to  the  social  worker. 
For  example,  "Man's  aunt,  Mrs.  Robert  Wilson, 
12   Pearl  St.;  woman's  former  employer,   Mrs. 
Lloyd  Doolittle,  54  Walford  Place." 

5.  Facts  about  the  person  interviewed  which 
make  for  or  against  his  reliability  as  a  witness. 
For  the  same  reasons  that  would  determine  the 
position  of  the  visitor's  initials  (see  item  2)  these 
should  come  at  the  beginning  of  the  interview. 

6.  Facts  told  by  the  person  interviewed.    (See 
discussion  of  the  arrangement  of  these  facts,  p.  128 
and  p.  134.) 

7.  Any  interpretation  of  the  facts  which  the 
person  interviewed  may  offer.   Mrs.  Jones'  sister 
may  say  that  she  thinks  Mr.  Jones  is  not  right 
mentally.   Any  facts  on  which  she  bases  this  in- 
terpretation of  his  conduct  should  usually  pre- 
cede it,  since  the  reader  wants  to  get  the  sister's 
evidence  free  from  the  bias  which  her  interpreta- 

125 


THE  SOCIAL  CASE  HISTORY 

tion  might  give  rise  to  in  his  mind.    Another 
illustration  is  as  follows: 

A  lady  who  had  asked  a  children's  agency  to  place  out 
the  daughter  of  an  old  acquaintance  of  hers,  told  of  a 
previous  unsuccessful  attempt  at  placing  the  girl  on  the 
part  of  friends.  Following  her  narrative  is  her  interpre- 
tation: 

"Mrs.  W.  feels  that  this  experience  is  chargeable  to 
ill-suited  placing  (i.e.,  placing  too  far  above  the  girl's 
capacity  for  development).  Considers  her  heedless  and 
stubborn,  fairly  bright,  not  immoral." 

8.  Any  plans  suggested  for  treatment  by  the 
person  interviewed. 

Although  this  order  of  items  is  not  offered  as  a 
hard  and  fast  one,  it  is  approximately  that  fol- 
lowed by  good  case  work  agencies  for  long  inter- 
views. The  many  short  entries  which  must  go 
into  records,  and  which  as  often  as  not  can  hardly 
be  described  as  "interviews"  at  all,  call  for  slight 
thought  as  to  arrangement.  Of  course  any  order- 
ing of  subject  matter  which  they  do  demand 
should  follow  that  of  the  long  entries.  Whatever 
order  of  items  an  agency  decides  to  use,  it  should 
hold  to  consistently,  in  order  to  save  the  dicta- 
tor's time,  and  also  in  order  that  the  reader  may 
126 


THE  NARRATIVE  IN  DETAIL 

know  where  in  any  interview  to  look  for  the  name 
of  the  visitor,  the  interpretation,  the  plans  of  the 
one  interviewed,  and  so  on.  It  is  also  time-saving 
to  use  a  routine  formula  in  opening  the  interview 
record,  whether  it  is  "Called  on  Mr.  X.,  526  M. 
St.,"  or  "Mr.  X.  seen  at  526  M.  St.,"  or  "Mr.  X., 
526  M.  St.,  says."  The  arrangement  of  the  first 
four  items  listed  above  is  a  simple  matter;  that 
of  item  6,  the  facts  told  by  the  person  interviewed, 
which  includes  the  interpretation  (7),  the  plan 
(8),  and  often  information  about  himself  (5)  calls 
for  analysis. 

AN  INTERVIEW  ARRANGED  AS  SUGGESTED 

Relationship,  Name  March  18,  1903.  (M.  F.  S.)  Called 
on  man's  aunt,  Mrs.  Robert  Wilson,  12  Pearl  St. 

Facts  re  aunt  affecting  testimony  For  the  last  5  years  she 
has  seen  man  only  occasionally  as  she  has  little  use  for 
his  wife,  and  he  resents  this.  Up  to  that  time  he  had 
been  almost  like  another  son  in  her  house.  He  was  a 
decent,  straight  fellow.  She  has  heard  that  since  he 
married  he  has  been  getting  like  his  wife's  family.  Her 
brothers  are  loud-mouthed,  profane  fellows,  and  she 
is  equal  to  either  of  them.  He  is  too  good  to  her  and 
lets  her  have  her  own  way  about  everything.  When 
they  were  first  married,  Mrs.  Wilson  tried  to  show  his 
127 


THE  SOCIAL  CASE  HISTORY 

wife  about  housekeeping,  but  Mrs.  S.  has  such  a  temper 
she  had  to  stop  going  to  his  house.  The  children  are 
attractive,  well-behaved  little  boys. 

Interpretation  Thinks  man's  sickness  due  to  his  wife's 
not  taking  care  of  him.  He  was  hardly  ever  sick  when 
he  stayed  with  aunt. 

Suggestion  for  treatment  Could  not  possibly  help  with 
money  as  she  has  so  many  expenses  to  meet,  and  could 
not  take  children  as  she  has  her  daughter's  children 
with  her  while  daughter  is  at  the  hospital.  Suggests 
that  Mrs.  S.'s  parents  be  approached. 

The  arrangement  of  the  facts  told  by  the  per- 
son interviewed  is  best  discussed  in  relation  to  the 
leading  interview  with  the  client  himself,  since 
that  is  more  likely  to  be  a  long  one  than  is  any 
other.  The  current  history  as  a  whole  sometimes 
opens  with  this  first  full  interview,  and  some- 
times with  a  statement  from  the  person  referring 
the  client  to  the  agency  for  care.  In  either  case, 
the  reason  for  applying  for  assistance  should  be 
stated  as  near  the  beginning  of  the  opening  para- 
graph as  possible.  The  history  should  start  off 
by  giving  the  reader  an  idea  of  the  general  type 
of  situation,  the  kind  of  need  he  is  to  consider. 
That  is,  he  should  know  at  once  whether  he  is  to 
128 


THE  NARRATIVE  IN  DETAIL 

read  about  a  woman  with  a  sick  husband  or  an 
unemployed  one,  a  wayward  or  a  dependent 
child,  a  heart  or  a  tuberculosis  case.  Although 
the  face  card  may  give  a  bare  statement  of  this, 
yet  since  the  first  sentence  of  the  opening  para- 
graph is  the  most  conspicuous  one  on  the  whole 
record,  repeated  mention  of  the  general  type  of 
situation  does  no  harm,  especially  when,  as  often 
happens,  the  person  referring  the  client  gives  an 
ampler  description  of  the  reason  for  asking  help 
than  the  face  card  admits  of.  When  once  the 
reader  knows  the  type  of  case,  he  can  arrange  the 
facts  as  he  reads  in  a  perspective  of  their  impor- 
tance for  future  treatment.  It  is  true  that  the 
need  as  seen  by  the  client  himself  or  by  the  one 
who  refers  him  for  care  may  be  no  more  than  a 
surface  indication  of  a  deeper  need.  Neverthe- 
less, since  the  deeper  need  may  not  appear  for 
some  time,  it  will  meanwhile  enable  the  reader 
to  keep  the  thread  of  the  story  clearer  if  he 
takes  it  up  with  at  least  a  tentative  notion  in 
his  mind  of  the  need  so  far  as  recognized.  If  one 
compares  the  first  few  sentences  of  the  illustra- 
tions that  follow,  one  notices  in  the  revised  ver- 
9  129 


THE  SOCIAL  CASE  HISTORY 

sion  an  immediate  feeling  of  "getting  there/' 
The  reader  learns  at  once,  in  a  general  fashion, 
enough  to  enable  him  to  pick  out  the  most  sig- 
nificant facts  as  he  gets  under  way.  This  makes 
reading  more  rapid,  a  consideration  we  need  to 
keep  before  us  in  record  writing. 


I.  ORIGINAL  VERSION 

June  5,  1916.  School  visitor,  Miss  F.,  refers.  She 
has  known  the  family  for  about  six  months,  Fannie  hav- 
ing been  referred  to  her  on  account  of  stubbornness. 
Fannie  used  to  be  late  to  school  every  morning  without 
adequate  reason,  and  when  reprimanded,  sulked  and 
would  say  nothing.  That  has  been  overcome,  however, 
and  now  the  teacher  has  nothing  to  complain  of  in  her 
conduct,  but  she  has  noticed  for  the  last  two  months  she 
has  not  been  looking  well  and  has  lost  the  color  in  her 
cheeks.  On  visiting  the  home,  Miss  F.  found  that  the 
father  had  been  ill  for  some  weeks  and  that  the  family  are 
in  straitened  circumstances.  The  parents  were  helpful 
in  doing  all  they  could  to  try  to  overcome  Fannie 's  fault. 
They  used  to  live  in  three  good  rooms  at  No.  25,  but 
since  Mr.  P.  has  been  ill,  they  have  moved  to  dark  and 
dreary  rooms  two  doors  away. 

Status  June  6,  1916.  Visitor  called.  Found  Mrs.  P. 
making  bread,  three  boarders  sitting  in  the  kitchen, 
and  Mr.  P.  in  bed  suffering  a  good  deal  of  pain.  The 

130 


THE  NARRATIVE  IN  DETAIL 

rooms  are  dark  and  gloomy,  but  they  were  reasonably 
clean,  and  the  little  children  were  unusually  clean  for 
the  early  morning. 

Past  life  Mr.  P.  says  that  he  was  a  peasant  in  Poland, 
and  worked  on  a  farm  for  others,  never  owning  any 
property  himself.  He  went  to  school  till  he  finished 
the  fourth  grade,  and  now  reads  Polish  papers  easily 
and  habitually.  Seven  years  ago  Mr.  P.  came  to  Merry- 
ville,  and  almost  immediately  got  work  with  the 
Merryville  Street  Railway  Co.  at  $2.00  a  day.  This 
work  he  has  kept  ever  since,  and  feels  sure  that  he  can 
go  back  to  it  as  soon  as  he  is  able  to  work.  The  family 
came  over  after  Mr.  P.  had  been  here  for  a  year  and  a 
half. 

Health  Five  years  ago  Mr.  P.  became  ill  with  rheuma- 
tism, and  for  four  months  was  unable  to  work.  This 
attack  lasted  from  February  till  June.  Two  years  ago 
he  had  a  recurrence  of  the  same  trouble,  and  this  time 
he  was  ill  for  eight  months,  from  about  April  till 
December.  He  went  to  Dr.  M.,  but  thinks  he  received 
no  benefit  from  the  treatment,  and  believes  what  he 
was  told,  that  there  is  no  use  trying  to  treat  rheuma- 
tism. The  present  attack  has  lasted  about  four 
months,  and  has  been  acute  for  the  last  two  months. 
Mr.  P.  has  had  no  doctor,  at  first  because  he  had  little 
faith  in  their  helping  him  and  now  because  he  has  no 
money.  He  is  willing  to  have  the  district  doctor  come 
in  to  see  him,  but  does  not  want  to  go  to  stay  at  a 
hospital  as  he  does  not  want  to  leave  his  family  alone. 

Finances     Mr.  P.  says  that  during  his  previous  attacks 


THE  SOCIAL  CASE  HISTORY 

the  family  got  along  on  his  savings.  Now  his  savings 
are  all  gone,  and  he  does  not  know  how  he  is  to  meet 
future  expenses.  The  family  has  had  three  boarders, 
but  the  Board  of  Health  has  ordered  them  out,  and 
they  are  on  the  point  of  leaving.  The  children  are  now 
eating  little  except  bread,  and  in  this  way  they  account 
for  Fannie 's  paleness. 

II.  SUGGESTED  REVISION 

June  5,  1916.  School  visitor,  Miss  F.,  refers  for 
family  care.  On  visiting  the  home  she  found  that  the 
father  had  been  ill  for  some  weeks,  and  that  the  family 
are  in  straitened  circumstances.  They  used  to  live  in 
three  good  rooms  at  No.  25,  but  since  Mr.  P.  has  been  ill 
they  have  moved  into  dark  and  dreary  rooms  two  doors 
away.  The  teacher  has  noticed  that  for  the  last  two 
months  Fannie  has  not  been  looking  well  and  has  lost 
the  color  in  her  cheeks. 

Miss  F.  has  known  the  family  for  about  six  months, 
Fannie  having  been  referred  to  her  on  account  of  stub- 
bornness. Fannie  used  to  be  late  to  school  every  morning 
without  any  adequate  reason,  and  when  reprimanded 
sulked  and  would  say  nothing.  The  parents  were  help- 
ful in  doing  all  they  could  to  try  to  overcome  Fannie 's 
fault,  and  now  the  teacher  has  nothing  to  complain  of  in 
her  conduct. 

Description  of  home  June  6,  1916.  Visitor  called. 
Found  Mrs.  P.  making  bread,  three  boarders  sitting 
in  the  kitchen.  The  rooms  are  dark  and  gloomy,  but 

132 


THE  NARRATIVE  IN  DETAIL 

they  were  reasonably  clean,  and  the  little  children  were 
unusually  clean  for  the  early  morning. 

Health  Mr.  P.  was  in  bed  suffering  a  good  deal  of  pain. 
Says  that  five  years  ago  he  became  ill  with  rheuma- 
tism, and  for  four  months  was  unable  to  work.  These 
attacks  lasted  from  February  till  June.  Two  years 
ago  he  had  a  recurrence  of  the  same  trouble,  and  this 
time  he  was  ill  for  eight  months,  from  about  April  till 
December.  He  went  to  Dr.  M.,  but  thinks  he  re- 
ceived no  benefit  from  the  treatment  and  believes 
what  he  was  told,  that  there  is  no  use  trying  to  treat 
rheumatism.  The  present  attack  has  lasted  about 
four  months,  and  has  been  acute  for  the  last  two 
months.  Mr.  P.  has  had  no  doctor,  at  first  because  he 
had  little  faith  in  their  helping  him  and  now  because 
he  has  no  money.  He  is  willing  to  have  the  district 
doctor  come  in  to  see  him,  but  does  not  want  to  go  to 
stay  at  a  hospital  as  he  does  not  want  to  leave  his 
family  alone. 

The  children  are  now  eating  little  except  bread,  and 
in  this  way  they  account  for  Fannie's  paleness. 

Status  Mr.  P.  says  that  he  was  a  peasant  in  Poland, 
and  worked  on  a  farm  for  others,  never  owning  any 
property  himself.  He  went  to  school  till  he  finished 
the  fourth  grade,  and  now  reads  Polish  papers  easily 
and  habitually.  The  family  came  over  after  Mr.  P. 
had  been  here  for  a  year  and  a  half. 

Employment  Seven  years  ago  Mr.  P.  came  to  Merry- 
ville,  and  almost  immediately  got  work  with  the 
Merryville  St.  Railway  at  $2.00  a  day.  This  work  he 

133 


THE  SOCIAL  CASE  HISTORY 

has  kept  ever  since,  and  feels  sure  that  he  can  go  back 
to  it  as  soon  as  he  is  able  to  work. 

Finances  Mr.  P.  says  that  during  his  previous  attacks 
the  family  got  along  on  his  savings.  Now  his  savings 
are  all  gone,  and  he  does  not  know  how  he  is  to  meet 
future  expenses.  The  family  has  had  three  boarders, 
but  the  Board  of  Health  has  ordered  them  out  and 
they  are  on  the  point  of  leaving. 

In  the  first  illustration,  the  school  visitor's  six 
months'  acquaintance  with  the  family,  while  it 
adds  weight  to  her  testimony  as  to  the  change  in 
their  home  conditions,  yet  as  given  at  this  point 
it  merely  keeps  one  waiting  to  learn  her  reason 
for  referring  the  family.  As  for  Fannie's  stub- 
bornness, the  inclusion  of  this  detail  at  the  begin- 
ning of  the  paragraph  gives  unintentional  em- 
phasis to  a  transient  childish  fault. 

The  first  full  interview. — When  the  history  opens 
with  the  first  full  interview,  it  is  a  mistake  for 
this  to  begin,  as  does  that  in  the  preceding  illus- 
tration, with  a  description  of  the  client's  sur- 
roundings. The  reader,  hurrying  through  these 
details  to  reach  the  gist  of  the  case,  would  give 
them  scant  and  impatient  attention.  When  the 
history  opens  with  an  * 'application"  statement 
134 


THE  NARRATIVE  IN  DETAIL 

which  gives  the  reason  for  referring  the  client  for 
help,  the  longer  interview  may  well  begin — as 
does  that  here — with  the  family  setting.  It 
should  be  immediately  and  quickly  followed, 
however,  by  a  detailed  account  of  the  present 
situation  as  to  need,  rather  than,  as  in  the  pre- 
ceding original  version,  with  the  man's  early  life. 
Important  to  the  social  worker  as  is  a  knowledge 
of  a  client's  background,  it  has  significance  only 
as  the  background  of  the  present  situation.  In 
other  words,  the  reader  needs  to  know  how  things 
are  with  the  client  today,  before  he  can  judge 
what  in  the  past  has  the  most  important  bearing 
on  the  treatment  of  his  present  difficulties. 

The  matter  in  this  chief  interview  should  be 
organized  according  to  topics.*  This  organization 

*  Mr.  Frank  J.  Bruno,  General  Secretary  of  the  Min- 
neapolis Associated  Charities,  suggests  the  following  ar- 
rangement for  the  chief  interview  (N.C.C.C.  1916,  p.  457): 
(i)  the  present  situation  of  the  client;  (2)  the  back- 
ground; (3)  the  surroundings,  i.  e.,  the  children,  the  home, 
and  the  references;  and  finally  (4)  the  tentative  outlook 
for  treatment.  Except  for  "references,"  which  the  present 
writer  would  put  on  the  face  card,  the  main  difference  be- 
tween Mr.  Bruno's  suggestion  and  that  above  is  that  the 
latter  carries  analysis  a  step  further. 

135 


THE  SOCIAL  CASE  HISTORY 

may  be  according  to  the  individuals  in  the  family: 
man,  woman,  children;  or  it  may  be  according  to 
those  broad  concepts  with  which  social  case 
treatment  deals:  health,  employment,  education, 
and  so  on.  The  former  division  of  the  matter 
brings  together  all  that  the  worker  has  learned 
about  each  member  of  the  client's  family,  in  this 
way  giving  a  rough  and  tentative  notion  of  them 
as  individuals;  the  latter  brings  together  all  facts 
about  health,  employment,  and  so  on,  whether 
concerning  parents  or  offspring,  thus  stimulating 
the  worker  to  notice  whether  there  is  a  relation 
between  the  health  of  the  parents  and  that  of  the 
children,  the  employment  of  the  man  and  that  of 
the  woman.  In  practice  these  two  ways  of  or- 
ganizing an  interview  would  always  in  a  sense  be 
combined,*  information  about  the  man,  for  in- 

*The  reader  will  notice  that  in  the  illustration  on  p.  133 
the  most  important  change  in  the  order  of  arrangement 
from  the  original  is  that  Health,  which  in  this  instance  is 
the  key  concept  to  the  present  situation,  has  been  put 
almost  at  the  beginning  of  the  interview  instead  of  after 
Status.  The  man's  health  being  the  crux  of  the  difficulty, 
and  the  conversation  having  been  with  him,  but  little  in- 
formation about  others  in  the  family  was  forthcoming. 
Two  lesser  changes  are  the  shifting  of  the  statement  as  to 

136 


THE  NARRATIVE  IN  DETAIL 

stance,  being  subdivided  under  health,  employ- 
ment, and  so  on,  whereas  information  on  health 
would  be  subdivided  according  to  persons. 

A  FIRST  INTERVIEW  ARRANGED  ACCORDING 
TO  THE  INDIVIDUALS  CONCERNED 

MAN  Health  June  21,  1910.  Reeder  called.  Found 
Mr.  F.  lying  in  bed  and  the  children  playing  on  the  fire 
escape.  Mr.  F.  looks  wasted  and  appears  to  have 
difficulty  in  talking;  his  breath  is  short  and  he  coughs 
frequently.  A  short  time  after  he  came  to  this  country 
he  had  bronchitis  which  left  him  weak  and  with  pains 
in  his  shoulders  and  side.  He  went  to  City  Hospital, 
out-patient  department,  for  treatment. 

Employment  Through  similar  attacks  he  has  usually 
managed  to  go  to  work.  His  boss  at  the  carpet 
factory  where  he  has  been  much  of  the  time  since  he 
came  to  America  understood  the  situation  and  sent 
him  out  of  doors  to  work  when  he  had  bad  attacks 
of  coughing  and  debility.  He  has  never  earned  more 
than  $18  a  week.  All  this  spring  he  had  a  push  cart 
and  sold  vegetables  and  fruit,  averaging  $15  a  week. 
He  was  obliged  to  give  this  up  a  month  and  a  half  ago. 

Early  Life  Mr.  F.  says  he  was  born  in  the  city  of  S. 
His  family  were  comfortably  situated.  His  father  was 
a  cook  for  ten  years  in  a  wealthy  family. 

when  Mr.  P.'s  family  came  to  this  country  from  the  cap- 
tion Employment  to  Status,  and  of  the  sentence  explain- 
ing Fannie's  paleness  from  the  caption  Finances  to  Health. 

137 


THE  SOCIAL  CASE  HISTORY 

Education  Mr.  F.  attended  school  for  a  year  or  so, 
but  played  truant  so  often  that  the  teacher  refused  to 
keep  him.  He  repented  later  that  he  had  not  taken 
advantage  of  his  educational  opportunities.  When 
very  young  he  was  apprenticed  in  a  shop  where  wine 
casks  were  made.  This  was  his  trade  up  to  twelve 
years  ago  when  he  came  to  U.  S.,  and  he  earned  60  to  75 
cents  a  day  at  it. 

Plan  Mr.  F.  has  decided  to  go  back  to  Italy  as  he  has 
been  planning  to  do  for  the  last  seven  years.  He  is 
resolved  that  nothing  shall  keep  him  from  going  this 
time.  A  collection  made  among  his  relatives  and 
friends  for  this  purpose  amounted  to  $20. 

WOMAN  Employment  Mrs.  F.  is  working  in  a  candy 
factory,  getting  $6.00  a  week.  She  comes  home  from 
work  tired  and  discouraged. 

Education  She  attended  school  in  Italy  and  previous  to 
marriage  was  a  milliner's  helper. 

Plan  She  is  opposed  to  having  her  husband  return  to 
Italy,  and  says  that  he  has  been  obsessed  with  that 
idea  for  the  last  seven  years. 

Impression  She  seems  slight  in  physique,  but  energetic 
and  rather  irritable. 

CHILDREN  Health  and  Care  The  two  older  are  very 
thin  with  little  color.  The  little  boy  of  three  looks 
strong.  All  are  obedient  and  clean. 

Here  we  get  a  good  notion  of  this  tuberculous 
man's  health,  employment,  early  opportunities, 


138 


THE  NARRATIVE  IN  DETAIL 

and  education,  and  of  his  plans  for  himself,  with 
fewer  facts  about  the  wife  and  children. 

A  FIRST  INTERVIEW  ARRANGED  BY  "KEY" 
CONCEPTS 

Health  Feb.  10,  1914  (C.  B.).  Mrs.  X.  at  home. 
Rooms  fairly  comfortable  but  untidy.  Asks  that  the 
three  youngest  children  be  taken  at  once  so  that  she 
may  get  a  rest.  Says  she  is  delicate  in  health  and  has 
more  than  she  can  do.  Someone  is  always  sick  in  her 
family.  Appears  overwrought  and  depressed.  Says 
Mr.  X.  has  suffered  from  rheumatism  continually  for 
the  last  few  years,  and  is  now  a  semi-invalid,  partially 
crippled. 

Jennie  has  heart  trouble  and  is  very  tired.  Mrs.  X. 
expects  her  to  have  to  give  up  work  any  day  as  she 
can't  stand  it  much  longer.  She  had  rheumatic  fever 
as  a  child. 

Frank  is  healthy-looking,  with  a  nervous  manner 
and  very  talkative.  His  mother  discusses  his  health 
and  nervous  condition  at  length  in  his  presence;  says 
he  is  better.  She  is  giving  him  strong  tea  and  cereal 
for  his  breakfast,  as  that  is  all  she  has,  although  the 
doctor  forbade  him  coffee  or  tea. 

The  two  little  children  are  pasty-looking,  but  are  not 
sick  at  present,  their  mother  says.  She  thinks  none 
of  the  family  sufficiently  nourished. 

Employment  Mr.  X.  has  just  started  in  to  work  after 
three  months'  sickness,  but  his  wife  does  not  know 
whether  he  will  be  able  to  hold  out  or  not.  He  is  a 

139 


THE  SOCIAL  CASE  HISTORY 

tailor,  in  business  for  himself,  and  makes  a  fair  income 
when  he  is  working,  $15  to  $18  a  week.  He  was  with 
Sullivan  McCurdy  Co.  for  ten  years  till  he  started  in 
for  himself  five  years  ago.  He  gets  very  discouraged 
and  is  not  a  man  to  stay  at  home  if  he  is  able  to  work. 
Jennie  has  been  at  the  rubber  factory  for  two  years. 
She  makes  $7.00  a  week  and  gives  it  all  to  her  mother. 
The  work  is  not  heavy,  but  she  feels  the  responsibility 
when  her  father  does  not  earn,  and  tries  to  help  at 
home  besides,  when  Mrs.  X's  strength  gives  out. 

Mrs.  X.  has  attempted  to  go  out  cleaning,  but  gets 
sick  every  time.  Says  she  can't  even  take  proper  care 
of  her  own  home. 

Education    Frank,  fourteen,  goes  to  the  Yorkville  School; 
is  in  the  eighth  grade.    Appears  unusually  bright,  evi- 
dently proud  of  having  kept  up  in  spite  of  absences. 
Josie,  ten,  at  the  Stuyvesant  School,  is  in  the  fourth 
grade. 

Tom,  seven,  in  the  second. 

Finances  Jennie's  earnings  have  been  the  only  in- 
come since  Mr.  X's  illness,  and  as  she  has  had  to  stay 
home  because  of  her  health  several  times,  she  has  not 
always  made  the  $7.00.  The  rent  is  two  months  be- 
hind, and  they  owe  the  grocer  $12.50.  No  other 
debts. 

Relatives  Man's  parents  are  dead.  He  has  one  brother 
living  in  Pike,  married,  with  seven  children;  has  all 
he  can  do  to  take  care  of  his  own  family. 

Woman's  father  dead,  her  mother,  Mrs.  Joseph 
Mulroy,  lives  with  a  single  sister  at  56  Westwood  St. 

140 


THE  NARRATIVE  IN  DETAIL 

A  married  sister  is  Mrs.  William  Fogarty,  327  Caldwell 
St.  None  of  these  people  could  take  the  children  or 
help  in  any  way,  she  thinks. 

In  this  last  interview  we  get  the  family  health, 
employment,  finances,  each  as  a  total  picture. 
Does  not  the  drawing  together  of  all  the  facts 
about  health  raise  the  question  as  to  whether 
there  may  not  be  something  wrong  with  the  fam- 
ily living  conditions,  whether  the  parents  do  not 
need  careful  education  in  health  laws  as  well  as 
material  relief?*  Of  course  an  agency  whose 
special  function  would  lead  it  to  treat  certain 
of  these  individuals  separately — Frank,  for  in- 
stance, or  his  younger  sister  and  brother — by  tak- 
ing them  out  of  the  home  for  a  period,  might  not 
regard  it  necessary  to  consider  their  health  in 
relation  to  that  of  their  family.  Yet  since  the 


*That  a  worker's  engrossment  in  the  health  of  one 
member  of  a  family  apart  from  that  of  the  others  often 
leads  to  halting  and  ineffective  treatment  has  become  im- 
pressed upon  the  writer  from  the  reading  of  many  records. 
This  is  especially  striking  where  undernourishment  may 
have  contributed  to  the  illness  of  the  patient.  Other 
members  of  the  family,  especially  the  children,  are  also 
likely  to  show  the  effects  of  insufficient  or  unnutritious  diet. 

141 


THE  SOCIAL  CASE  HISTORY 

children  would  presumably  have  to  return  to 
their  parents  at  some  time  or  other,  a  progressive 
children's  agency  would  probably  feel  that  they 
had  better  go  back  to  parents  who  had  been 
taught  the  laws  of  health  and  who  had  earnings 
adequate  for  carrying  them  out.  In  other  words, 
such  an  agency  would  feel  that  it  must  take  ac- 
count of  the  health  as  well  as  the  occupation  and 
earnings  of  this  whole  family.  The  facts  on  em- 
ployment also,  it  would  find,  when  those  of  the 
whole  family  are  brought  together,  would  show 
the  effect  which  the  parents'  inadequacy  to  their 
responsibilities  is  having  upon  the  daughter,  both 
as  to  her  tenure  of  employment  and  as  to  her 
health. 

Which  of  these  two  methods  of  arrangement 
one  uses  would  depend  upon  the  sum-total  of 
facts  which  the  investigator  gets  from  the  client. 
When  the  need,  as  in  the  illustrations  on  pp.  132 
and  137,  arises  mainly  from  a  disability  in  one 
member  of  a  family,  naturally  the  worker  will  be 
likely  to  have  more  information  about  him  than 
about  the  others  and  will  arrange  her  recorded 
interview  under  the  head  of  the  various  persons 
142 


THE  NARRATIVE  IN  DETAIL 

in  the  family  group.  When,  as  in  the  illustration 
on  p.  139,  the  need  arises  from  disabilities  in  more 
than  one  member  of  the  family,  the  worker  may 
get  much  matter  about  several  of  the  group,  and 
so  may  find  it  clearer  to  organize  it  under  the 
general  social  concepts.  In  either  case,  what  she 
should  do  is  to  go  over  her  facts  before  she  dic- 
tates, noting  which  are  the  most  salient,  and 
selecting  captions  to  arrange  them  under  ac- 
cordingly. To  dictate  the  story  as  it  has  come 
from  the  client,  who  is  quite  possibly  not  clear- 
headed, is  to  give  the  reader  a  confused  account 
of  that  which  must  be  appraised  not  as  just 
friendly  talk  but  as  a  problem  demanding  solu- 
tion. As  before  shown,  the  first  business  of  the 
record  is  so  to  arrange  the  facts  in  the  client's 
situation  that  they  reveal  the  problem. 

In  the  collateral  investigation  the  interviews 
with  employers,  relatives,  and  others,  should  each 
be  organized  after  the  same  general  plan  as  the 
interview  with  the  client.* 

The   Diagnostic   Summary. — A  feature   of    the 
record  which  should  prove  as  important  as  any 
*  For  illustration  see  p.  127. 
143 


THE  SOCIAL  CASE  HISTORY 

and  yet  which  has  not  yet  been  generally  adopted 
by  case  workers,  is  a  definite  statement  of  the 
problem  or  problems  presented  in  the  client's 
situation,  a  diagnostic  summary  of  the  evidence 
brought  out  in  investigation.*  Anyone  who  has 
done  much  record  reading  knows  how  often  it  is 
that  even  the  careful  reader  has  to  turn  to  the 
visitor  on  the  case  in  order  to  find  what  the  diffi- 
culty is.  Indeed,  without  this  supplementing  of 
the  history,  one  who  wishes  to  see  the  situation 
as  it  looks  to  the  visitor  who  has  been  talking  and 
working  with  the  client  must  read  a  history 
through  slowly  once,  and  then  go  back  labori- 
ously and  work  out  an  interpretation  of  its  evi- 
dence. This  interpretation  is  "diagnosis,"  the 
process  of  getting  at  the  key  conceptions  to  which 
the  facts  in  case  histories  point. 

Key  concepts  and  causal  factors. — Let  us  pause 
for  a  moment  to  consider  what  is  involved  in 
making  an  interpretation  of  a  client's  problem. 
It  should  not  be  called  "interpreting"  a  case 
merely  to  select  out  from  the  recorded  items  any 

*Richmond,  Mary  E.:  Social  Diagnosis,  p.  361.  Russell 
Sage  Foundation,  1917. 

144 


THE  NARRATIVE  IN  DETAIL 

one  or  two  causal  factors.  This  is  rather  the  pre- 
liminary step  toward  interpretation.  What  has 
just  been  called  the  "conception"  to  which  the 
facts  in  the  case  point  is  simply  the  idea  of  the 
whole  network  of  cause-effect  items  which  con- 
stitute it  a  "case."  That  is,  the  conception  of  a 
case  of  tuberculosis  is  the  total  composite  idea  of 
such  items  as  insufficient  light  and  air,  under- 
nourishment, ignorance  of  hygiene,  depleted 
vigor,  delayed  or  disregarded  medical  advice,  the 
tubercle  bacillus,  overexertion,  unemployment, 
and  so  on,  some  of  these  being  what  in  common 
parlance  we  call  "causes"  of  certain  of  the  others, 
and  some  "effects."  The  social  diagnosis  must 
include  this  whole  nexus  of  causal  factors  which 
make  up  its  explanation.  Take,  for  instance,  the 
sample  "Diagnostic  Summary"  suggested  by 
Miss  Richmond.*  This  is  an  interpretation  of  the 
needs  of  a  family  in  which  the  husband  and  father 
has  fairly  advanced  tuberculosis,  and  the  wife 
and  children  are  not  vigorous.  As  the  man  is  un- 
skilled and  has  been  ill  some  time,  there  are  no 
savings.  The  man  had  not  responded  to  his  phy- 

*  Opus  cit.,  p.  361. 
10  145 


THE  SOCIAL  CASE  HISTORY 

sician's  advice  that  he  go  to  a  sanatorium,  and  it 
developed  that  his  wife  opposed  his  going  partly 
because  she  did  not  realize  the  seriousness  of  his 
condition,  and  partly  because  she  feared  lest  her 
home  be  broken  up  and  the  family  separated. 
Once  the  social  worker  had  convinced  her  on 
these  two  points,  her  husband  went  away  for  the 
needed  care.  As  causal  factors  in  the  case  Miss 
Richmond  gives  the  wife's  reasons  for  influencing 
her  husband  to  remain  at  home — her  failure  to 
appreciate  his  condition,  her  fear  that  the  family 
would  be  separated.  These  certainly  are  causal 
factors,  but  the  worker  should  press  on  to  the 
question,  What  do  they  point  to?  What  concept 
or  concepts  do  they  indicate  as  explaining  them 
and  as  calling  attention  to  other  facts  in  the  case 
which  may  confirm  this  explanation?  Does  not 
the  wife's  failure  to  appreciate  her  husband's  con- 
dition even  after  he  had  got  a  physician's  advice 
indicate  "ignorance  of  the  laws  of  health"?  Had 
the  worker  identified  such  ignorance  as  a  key 
concept  to  which  this  fact  could  be  referred,  her 
experience  would  have  told  her  that  included  in 
this  concept  "a  mother  uninformed  as  to  health 
146 


THE  NARRATIVE  IN  DETAIL 

laws"  is  the  failure  to  observe  and  know  the 
meaning  of  the  less  acute  or  conspicuous  symp- 
toms of  illness  and  the  taking  for  granted  of  a 
certain  amount  of  slight  ailment  (as  an  ignorant 
person  would  think  it)  in  children  or  in  a  married 
woman.  Ignorant  mothers  are  often  both  unob- 
servant and  fatalistic.  Workers  are  all  familiar 
with  the  resigned  acceptance  of  preventable  ill- 
ness expressed  in  the  words  "it  was  to  be.'1  The 
recollection  of  this  recurring  fatalism  would  have 
led  the  worker  to  look  to  the  amount  and  kind  of 
attention  which  the  mother  was  giving  to  her  own 
and  her  children's  lack  of  vigor  for  a  confirmation 
of  this  worker's  hypothesis  as  to  maternal  ignor- 
ance. The  worker  would  then  have  induced  her 
to  go  to  a  doctor,  would  have  learned  that  she 
was  herself  tuberculous;  and  would  have  seen 
that  she  had  instruction  in  hygiene.  Thus  the 
one  omission  in  an  otherwise  well-handled  case 
would  have  been  avoided.  The  worker  fell  short 
in  her  diagnosis,  and  therefore  in  her  treatment 
of  this  family,  just  where  her  thinking  lacked 
definiteness.  The  causal  factors  in  this  instance 
are  all  the  factors  which  correspond  to  the  com- 
147 


THE  SOCIAL  CASE  HISTORY 

ponent  parts  of  the  concept  "wife  and  mother 
ignorant  of  health  laws."  The  second  causal 
factor  given  by  Miss  Richmond,  the  wife's  fear 
that  her  home  might  be  broken  up  if  her  husband 
went  to  a  sanatorium,  points  to  a  different  con- 
ception, "ignorance  of  social  resources."  Such 
ignorance  is  so  common  in  clients  that  the  fact 
and  its  significance  may  be  said  to  have  become 
identified  as  one  key  to  their  conduct. 

Since  any  interpretation  of  facts  relates  them  to 
a  key  concept,  the  interpretation  of  social  facts, 
which  in  case  work  lie  in  many  relations  of  the 
client's  life,  relates  them  not  to  one  concept  but  to 
what  might  be  described  as  a  constellation  of  con- 
cepts. Some  of  these  meanings  may  be  economic, 
some  medical,  some  psychological  and  social.  For 
this  reason  Miss  Richmond's  term  "Diagnostic 
Summary"  for  the  statement  of  an  interpretation 
in  social  case  work  is  more  accurate  than  the  word 
"diagnosis,"  which  carries  associations  from  med- 
ical cases  where  a  single  causal  factor  may  ex- 
plain the  difficulty.*  It  is  possible  that  these  con- 

*As  to  whether  or  not  even  medical  diagnoses  will  con- 
tinue to  be  regarded  as  complete  which  leave  out  of  account 

148 


THE  NARRATIVE  IN  DETAIL 

stellations  of  meanings,  or  of  causally  interwoven 
factors — different  names  for  the  same  thing — are 
recurringly  constant.  That  is,  more  knowledge 
and  study  may  show  that  a  certain  type  of  sex 
misconduct  in  a  girl  is  accompanied  by  other 
fairly  constant  characteristic  social  relationships 
and  economic  situation,  that  a  given  sort  of  men- 
tal make-up  is  found  again  and  again  in  conjunc- 
tion with  the  same  social  maladjustments.  A  few 
years  ago  social  workers  assumed  such  a  constant 
conjunction  to  exist  between  feeble-mindedness 
and  filth,  immorality,  drunkenness,  disease,  un- 
employment, petty  crime,  dependence.  Today 
we  speak  with  more  caution,  wider  knowledge 
having  shown  us  that  different  kinds  and  degrees 
of  mental  defect  carry  with  them  different  kinds 
and  degrees  of  social  disability.  Just  what  these 

important  causal  factors  of  a  social  sort,  the  layman 
should  perhaps  withhold  himself  from  speculating.  For 
several  years  the  social  symptoms  in  mental  cases  have 
been  listed  by  the  Boston  Psychopathic  Hospital  Social 
Service  with  a  view  to  determining  whether  any  such  per- 
sistent relation  between  maladjustments  exists;  whether, 
in  short,  we  shall  in  time  be  able  to  classify  and  to  name 
our  various  social  diagnoses  with  a  precision  comparable 
to  that  of  diagnosis  in  medicine. 

149 


THE  SOCIAL  CASE  HISTORY 

differences  are  we  know  as  yet  only  in  a  tentative 
way. 

The  marshalling  of  the  causal  factors. — The  pres- 
ent writer  strongly  advocates  the  making  of  a 
diagnostic  summary  at  the  close  of  the  investiga- 
tion into  a  client's  need.  The  following  example 
will  show  what  such  a  summary  does.  The  causal 
factors  in  the  case  can  be  listed  under  captions 
that  correspond  to  the  following  general  scheme 
of  analysis  :* 

I.  THE  PHYSICAL  AND  MENTAL  BASIS  OF  THE  CASE 

A.  Heredity 

B.  Physical  Development 

C.  Mental  Development 

II.  RELATIONSHIPS  INVOLVING  ADJUSTMENTS  OF  CHAR- 
ACTER AND  SOCIAL  SITUATION 

A.  Family 

B.  Sex 

C.  Occupation 

D.  Recreation 

E.  Religion 

F.  Rehabilitation 

*As  is  evident,  Division  II  of  this  scheme  uses  the 
various  social  relationships  as  the  basis  of  analysis. 

150 


THE  NARRATIVE  IN  DETAIL 

As  applied  in  a  specific  instance,  the  summary  takes 
some  such  form  as  follows: 

FACTORS  IN  MURRAY  CASE  (NON-SUPPORT) 
Frank  40  Robert        9 

Theresa        38  Sarah          7 

Grace          5 
John  2 

MAN.  I. 

A.  Inconclusive  Heredity:*  his  father  an  English  clergy- 
man; his  younger  brother's  mind  gave  way  from  over- 
study  (according  to  wife). 

B.  Physical  Development ? 

C.  Mental  Development.   Unstable?   (Layman's  query.) 
A  self-extoller,  lying,  roving,  thieving  (see  below). 

II. 

A.  Family.  Irresponsible  husband  and  father:  affection- 
ate with  his  children;  defrauds  family  by  pawning 
household  effects  and  incurring  debts  in  wife's  name; 
one  desertion  of  two  months;  household  unsettled  by 
frequent  changes  of  habitat. 

*The  writer  offers  the  diagnostic  terms  used  here  and  on 
pages  169  sq.  as  merely  tentative.  The  coining  of  apt 
descriptive  phrases  for  the  purpose  of  diagnosis  and  the 
getting  them  uniformly  accepted  might  well  be  under- 
taken by  a  committee  on  terminology.  For  a  long  time 
to  come  the  concepts,  as  in  the  illustration,  will  need  to  be 
followed  by  the  evidence,  since  otherwise  one  worker  will 
take  "irresponsible  father,"  for  instance,  to  mean  something 
quite  different  from  what  another  does. 


THE  SOCIAL  CASE  HISTORY 


B.  Sex ? 

C.  Occupation.     Doubtful   employability:     earning    ca- 
pacity $60  per  week  when  at  his  best;   dishonesty — 
petty  larceny  and  forgery,  lying,  roving  disposition. 

D.  Recreation ? 

E.  Religion—  — ? 

F.  Rehabilitation.     Non-support    treatment:     man    in 
jail  for  six  months. 

WIFE.  I. 

A.  Inconclusive    Heredity:     father    a    crippled    tailor; 
mother  reported  as  tidy  but  not  intelligent;  sister  Nora 
unresponsive,  appears  dull,  indiscreet  with  employer. 

B.  Physical  Development ? 

C.  Mental  Development.  Subnormal?  (Layman's query.) 
State  of  upset  nerves. 

II. 

A.  Family.     Unintentional   neglect    of  children:     much 
concerned  for  children's  welfare;    shows  sense  of  re- 
sponsibility; determined  man  shall  not  return  to  make 
trouble;  away  from  home  at  work  but  cannot  control 
children  when  at  home;  respectable;  children  all  lack 
vigor  and  all  disobedient;  oldest  boy  (nine  years)  roams 
streets,  has  begun  smoking,  has  had  bad  influence  on 
sisters. 

Fraternal  affection:  sister  available  as  contributor 
and  helper  with  children. 

B.  Sex ? 

C.  Occupation.    Poor   home-maker;    untidy   in   person 

152 


THE  NARRATIVE  IN  DETAIL 

and  household;   can  earn  $7.00  to  $8.00  per  week  at 
office  cleaning;  overworked. 

D.  Recreation ? 

E.  Religion ? 

F.  Rehabilitation.     Treatment  for  overworked  dependent 
mother  of  doubtful  efficiency:    open   to   advice   from 
church  and  from  social  agency. 

Each  of  the  conceptual  factors  named  in  this 
outline  is  followed  either  by  sub-factors  which 
bear  a  causal  relation  to  it  or  by  a  defining  of  the 
factor  itself.  Thus  the  factor  "doubtful  employ- 
ability"  is  followed  by  its  causal  sub-factors 
"dishonesty,"  "roving  disposition,"  whereas  the 
factor  "irresponsible  husband  and  father"  gets 
defined  by  the  sub-factors  "one  desertion  of 
two  months,"  "household  unsettled  by  frequent 
change  of  habitat";  and  the  factor  "woman's 
unintentional  neglect  of  children"  gets  defined  by 
the  items  "much  concerned  for  children's  wel- 
fare," "cannot  control  them,"  "children  all  lack 
vigor  and  all  disobedient,"  and  is  also  followed  by 
a  causal  sub-factor  "away  from  home  at  work." 
The  conceptual  factors  "unstable"  and  "subnor- 
mal" would  of  course  be  admissible  keys  to  causal 
sub-factors  in  the  case  were  they  more  than  a 
153 


THE  SOCIAL  CASE  HISTORY 

layman's  guess.  Fundamental  as  are  disabilities 
of  a  mental  sort,  in  a  social  diagnosis  it  is  the 
social  aspect  of  character;  namely,  conduct,  re- 
lations with  people,  which  should  be  emphasized; 
so  that  the  medical,  including  mental,  explana- 
tions of  conduct  must  hold  for  our  descriptive 
purposes  a  subsidiary  place.  Therefore,  even 
though  we  knew  from  competent  medical  opinion 
that  the  man  in  the  family  cited  showed  a  psy- 
chosis and  the  woman  some  slight  defect,  we 
should  yet  in  our  own  social  description  name  the 
outstanding  factors  employ  ability,  poor  home-mak- 
ing, neglect.  These  are  the  phenomena  which  as 
social  workers  we  are  primarily  concerned  to 
influence. 

The  diagnostic  summary  here  given  shows  the 
1 'constellation  of  conceptions"  spoken  of  on  p.  148 ; 
namely,  "irresponsible  husband  and  father/' 
"doubtful  employability,"  "subnormal  (?)  men- 
tality," "unintentional  neglect  of  children," 
"poor  home-maker"  as  general  conceptions,  and 
"self-extoller,"  "unsettled  household,"  "dishon- 
esty," "upset  nerves,"  "disobedience  of  children/' 
and  "overwork  of  mother"  as  specific  subsidiary 
154 


THE  NARRATIVE  IN  DETAIL 

concepts  and  causal  sub-factors.*  These  are  the 
concepts  which  point  to  treatment,  and  are  there- 
fore the  ones  which  should  stand  out  at  the  place 
in  the  record  where  investigation  ends  and  treat- 
ment begins.  It  takes  time  to  make  such  a  sum- 
mary. The  question  to  be  answered  is,  however, 
does  it  take  more  time  than  it  does  to  do  the 
thinking  that  must  precede  the  most  effective 
treatment?  It  has  struck  the  writer  that  some- 
times when  an  outsider  who  has  read  a  record 
turns  to  the  worker,  as  she  often  must,  in  order  to 
find  out  what  the  trouble  is  all  about,  the  worker 
for  the  first  time  sets  herself  to  interpret  the  evi- 
dence she  has  got.  She  improvises  a  diagnostic 
summary  under  someone  else's  challenge.  For 

*A  comparison  of  the  social  problem  diagnosed  on  p.  151 
with  that  outlined  on  p.  169  will  show  both  to  be  problems  of 
non-support  and  both  to  number  among  their  factors  of 
maladjustment  (see  Chapter  VII,  p.  208)  doubtful  employa- 
bility  as  a  general  concept,  and  dishonesty  and  possibly 
mental  disorder  as  concepts  subsidiary  to  this  one.  In  spite 
of  possibly  important  differences  between  the  two  men 
and  in  spite  of  the  lack  of  information  to  make  the  two 
diagnoses  strictly  comparable,  there  is  enough  resemblance 
between  the  two  to  illustrate  the  suggestion  that  certain 
maladjustments  recur  in  conjunction  because  there  are 
causal  relations  to  be  disclosed  among  them. 

155 


THE  SOCIAL  CASE  HISTORY 

the  sake  of  her  client  she  should  take  time  to 
make  this  interpretation  without  depending  upon 
the  chance  of  a  personal  stimulus. 

The  resulting  plan. — After  the  worker  has  made 
out  such  a  summary,  she  is  ready  to  form  a  plan 
of  treatment  herself  or  to  ask  a  committee  to  form 
it.  The  plan  entered  on  the  record  should  indi- 
cate the  immediate  steps  to  be  taken  to  help  the 
client,  but  always  with  a  view  to  their  bearing 
on  the  larger  purpose  foreshadowed  in  the  con- 
cepts of  maladjustment  as  given  in  the  diagnostic 
summary.  The  details  in  case  work  treatment 
are  so  numerous  and  at  least  temporarily  so  im- 
portant that  it  is  easy  for  the  worker  to  lose  her 
sense  of  proportion  between  means  and  ends.  It 
is  easy  for  the  placing-out  visitor,  for  example,  to 
think  of  the  purchase  of  a  spring  suit,  which  is  a 
means  to  the  child's  need  of  warmth,  proper  as- 
sociates, and  self-respect,  as  an  end  in  itself.  It 
is  easy  for  the  secretary  in  a  family  agency  to  lose 
sight  of  the  fact  that  the  allowance  raised  for  a 
widow  from  several  sources  with  unremitting 
labor  is  but  a  means  toward  good  standards  in 
home  life.  The  moment  the  worker  lets  herself 

156 


THE  NARRATIVE  IN  DETAIL 

forget  the  larger  need,  she  will  find  her  absorption 
in  details  reflected  in  a  loss  of  perspective  in  her 
record.  Important  things  will  appear  small  in 
a  history  where  small  things  are  always  to  the 
fore.  She  then  must  hold  before  her  mind  the 
major  concepts  of  maladjustment  in  her  client's 
case  with  their  treatment  implications. 

Even  if,  as  will  sometimes  be  the  case,  the 
investigation  fails  to  indicate  one  course  of  treat- 
ment as  preferable  to  another  (or,  in  other  words, 
to  point  to  the  diagnosis  with  reasonable  cer- 
tainty), a  worker  of  experience  will  always  have 
some  ground,  however  meager,  for  a  tentative 
diagnosis  and  plan.  The  treatment  evidence  that 
follows  and  that  shows  the  testing  of  the  plan 
should  have  a  cumulative  import  that  will  reveal 
the  correctness  or  incorrectness  of  the  worker's 
diagnosis  of  her  client's  need. 

The  committee  vote,  the  supervisor's  direc- 
tions, or  the  worker's  plan,  ought  to  fill  as  im- 
portant a  place  in  the  history  as  it  is  recognized 
to  fill  in  the  actual  business  of  helping  a  client. 
Writing  a  vote  in  red  ink  is  merely  a  formal 
recognition  that  it  ought  to  be  important.  To  be 
157 


THE  SOCIAL  CASE  HISTORY 

really  important,  i.  e.,  to  influence  the  succeeding 
treatment,  it  (i)  must  be  based  on  an  interpreta- 
tion of  the  client's  situation,  (2)  must  be  specific, 
and  (3)  unless  the  reason  for  the  plan  is  clear  on 
the  face  of  things  must  give  that  reason.  Where 
the  worker  has  made  no  diagnostic  summary, 
her  committee's  vote  is  apt  to  fall  short  of  these 
requisites.  For  example,  a  worker  whose  prob- 
lem, as  her  recording  shows,  was  that  of  a  peri- 
odic hard  drinker  and  an  amiable  but  incom- 
petent housewife,  received  from  her  committee 
the  following  directions  within  one  month: 

Ask  minister  to  take  an  interest  in  the  family.  Provide 
shoes  for  the  little  boys  so  that  they  can  enter  school. 

(Two  weeks  later)  Ask  dietitian  to  try  the  family  for 
a  month  and  then  reconsider  income. 

(One  week  later)  Investigate  work  with  alcoholism 
among  men  at  Foster  Hospital  clinic. 

A  careful  diagnostic  summary  of  this  family's 
need  as  it  appears  from  the  investigation  would 
have  supplied  the  basis  for  a  plan  to  include  all 
of  these  directions  from  the  outset.  This  would 
have  hastened  treatment.  Then  the  first  vote 
might  well  have  stated  specifically  what  was  ex- 
158 


THE  NARRATIVE  IN  DETAIL 

pected  of  the  minister,  the  second  vote  might 
have  given  the  reason  for  a  reconsideration  of  the 
family  income,  and  the  third  vote  the  purpose  of 
the  inquiry  at  the  dispensary.  All  this  would 
make  the  total  plan  read : 

Ask  the  minister  to  persuade  the  parents  to  attend 
church  and  to  send  the  children  to  Sunday  school;  to 
urge  the  man  to  take  the  pledge  and  join  the  Men's  Club 
connected  with  the  church.  Ask  the  dietitian  to  visit  the 
family  for  a  month  in  order  to  determine  whether  the 
man's  income  is  too  small  to  be  a  case  for  supervision. 
Investigate  work  with  alcoholism  among  men  at  the  Foster 
Hospital  clinic  to  learn  whether  they  deal  with  men  who 
are  neither  chronic  nor  confirmed  drunkards,  and  if  they 
do,  consult  Dr.  X.  about  Mr.  G's  case. 

A  children's  agency  shows  the  following  out- 
line for  treatment  of  a  wayward  girl: 

Place  out  to  ascertain  whether  Margaret  can  respond 
to  good  influences,  or  whether  she  is  defective  or  psycho- 
neurotic.  At  end  of  six  months  take  to  Dr.  S.  for  re-ex- 
amination. She  should  be  observed  as  to 

1.  Health,  especially  cleanliness  and  sex  life. 

2.  Powers  of  work  in  household  duties  and  in  school, 
especially  arithmetic  (her  weak  point)  and  music  (her 
strong  point). 

3.  Moral  traits,  especially  truthfulness  and  honesty. 

159 


THE  SOCIAL  CASE  HISTORY 

This  recommendation  gives  evidence  that  it  has 
been  preceded  by  a  tentative  diagnosis  of  the 
girl's  difficulties,  a  diagnosis  which  is  to  be  con- 
firmed or  set  aside  according  to  the  result  of 
treatment;  it  specifies  what  is  expected  of  the 
visitor  in  the  case;  and  presents  the  reason  for 
the  plan,  i.  e.,  to  get  an  accurate  understanding  of 
the  girl's  traits  and  possibilities.  Compare  such 
an  outline  with  the  mere  bald  entries,  "Accept 
girl  for  placement,"  or  "Place  out  with  motherly 
woman."  The  fuller  outline  not  only  makes  a 
record  easier  reading,  it  also  encourages  the  vis- 
itor toward  purposeful  thinking  and  action. 

With  a  diagnostic  summary  and  a  specific  plan, 
treatment  of  a  client's  need  thus  gains  in  purpose 
and  therefore  in  effectiveness.  One  might  say 
that  the  worker  does  more  significant  things,  in 
the  sense  that  what  she  does  for  the  client  points 
to  or  is  moving  toward  some  clearly  conceived 
end.  Every  entry  in  the  record  should  have  a 
relation  to  this  end,  either  by  way  of  furthering 
it  or  by  showing  why  it  cannot  be  furthered.  Pur- 
posefulness  of  treatment,  however,  does  not  mean 
that  the  worker  should  make  a  hard  and  fast  plan 
160 


THE  NARRATIVE  IN  DETAIL 

and  impose  it  upon  her  client.  The  best  of  plans 
must  be  held  subject  to  constant  revisings  as  the 
client's  situation  alters  in  one  respect  or  another, 
and  all  treatment  adapts  itself  to  the  client's 
wishes  and  ambitions. 


ii  161 


VI 
THE  NARRATIVE  IN  DETAIL  (Continued) 

T7OLLOWING  the  plan  for  treatment  come 
*•  the  pages  of  the  record  devoted  to  the  story  of 
the  treatment  itself  and  of  the  continuing  devel- 
opment of  the  problem.  This  part  of  the  narra- 
tive history  is  especially  apt  to  be  confused,  be- 
cause the  subject  matter  changes  from  one  para- 
graph to  another. 

The  Record  of  Treatment. — Treatment  items  a 
melange. — On  a  single  page  the  mind  of  the  reader 
may  have  to  switch  from  health  to  finances,  from 
behavior  to  winter  underwear,  from  the  securing 
of  a  non-support  warrant  to  a  letter  of  thanks  for 
a  Christmas  dinner.  This  makes  for  an  extremely 
disconnected  "narrative,"  as  the  illustrations 
which  follow  show.  The  words  in  the  margin  note 
the  change  of  topic.  These  excerpts  from  good 
records  of  two  well-handled  clients  are  typical. 
It  is  evident  that  in  recording  treatment  we  can- 
not even  aim  at  a  connected  narrative  in  the 
162 


THE  NARRATIVE  IN  DETAIL 

sense  meant  by  the  rhetoric  books.  The  second 
illustration,  that  from  a  family  problem,  shows 
especial  disconnectedness,  the  subject  here  shift- 
ing not  only  from  topic  to  topic,  but  from  one 
member  of  the  family  to  another.  Because  of 
these  constant  breaks  in  the  thread  of  the  story 
it  is  more  difficult  for  family  than  for  other  case 
work  agencies  to  make  their  records  clear.  While 
reading  a  number  of  records  of  family  agencies, 
the  present  writer  has  found  herself  from  time  to 
time  noting  one  or  another  history  as  being  re- 
markably easy  to  grasp.  In  every  instance  it 
proved  to  be  a  family  in  which  the  problem  was 
pretty  much  confined  to  one  member:  illness  in 
the  father,  erratic  conduct  in  the  mother,  special 
training  for  son  or  daughter.  The  records  of 
children's  and  of  medical  agencies  have  always 
this  advantage  of  a  relative  singleness  of  aim, 
since  they  are  concerned  each  with  one  client,  as 
a  rule,  and  with  a  fairly  definite  problem  as  shown 
in  that  client.*  Compare,  for  example,  the  two 

*If,  as  may  happen,  family  agencies  develop  more  in- 
tensive care  for  the  children  in  the  household,  the  writer 
questions  whether  it  may  not  become  advisable  for  the 

163 


THE  SOCIAL  CASE  HISTORY 

treatment  records  that  follow.  The  italicized 
marginal  comments  indicate  the  changes  in  the 
subject  matter  of  the  paragraph. 

TREATMENT  RECORD 

A  boarded-out  boy  of  thirteen,  troublesome  and  not 
vigorous. 

Special  lessons  Sept.  9,  '15.  Telephone  from  Mr.  Foley, 
Clarence's  boxing  teacher,  Pottstown,  Clarence  making 
good  progress. 

Edtication  and    Conduct    Sept.    22,    '15.    Letter  from 

Mrs.  Shirmer,  foster  mother,  Berlin,  Clarence  well. 

Enjoys  school  and  learns  easily.    The  teacher  likes 
him.    Still  fibs,  but  shows  some  improvement. 

sake  of  clarity  and  time  saving,  that  they  should  have  a 
sheet  for  each  child,  separate  but  kept  in  the  folder  with 
the  family  history.  Even  should  a  family  agency  work 
with  but  one  child  it  might,  unless  no  family  problem  exists, 
use  a  separate  sheet  so  as  to  keep  this  one  child's  develop- 
ment from  completely  overshadowing  problems  affecting 
the  family  as  a  whole.  The  objection  which  has  been 
raised  to  this  proposal  is  that  the  reader  would  lose  the 
bearing  which  the  family  history  had  on  the  child,  and 
vice  versa.  Such  an  objection  would  have  weight,  were 
the  reader  able  to  get  at  this  bearing  readily  at  present. 
As  it  is,  however,  almost  any  method  is  worth  at  least 
trying  out  which  promises  to  bring  greater  consecutive- 
ness  into  treatment  records. 

164 


THE  NARRATIVE  IN  DETAIL 

Health  Oct.  13,  '15.  Mrs.  S.,  foster  mother,  Berlin. 
Clarence  walks  to  school  twice  each  day,  a  mile  and  a 
half,  and  enjoys  the  exercise.  Also  Sunday  the  same 
distance  to  church. 

Conduct,  Education    Now  keeps  himself  clean  with  less 
prodding  and  is  more  satisfactory  at  chores  about  the 
barn.    At  open  air  school  entered  sixth  grade  and  is 
doing  well. 
Oct.  15,  '15.    Letter  from  ditto  to  same  effect. 

Conduct  Oct.  30,  '15.  Letter  from  ditto.  Has  had 
Clarence  discontinue  boxing  lessons  because  he  is  in- 
clined to  pick  up  acquaintances  en  route  with  loafers 
around  the  billiard  room  and  saloon,  and  so  on.  Foster 
mother  feels  she  must  watch  him  pretty  closely. 

C's  father  Nov.  17/15.  Letter  from  ditto.  Clarence's 
father  has  visited  him.  Went  to  Clarence's  school  and 
showed  pleasure  at  his  improvement. 

Health  and  Conduct  Nov.  23,  '15.  Letter  from  ditto. 
Clarence's  health  improved.  School  report  rates  his 
conduct  as  80— only  fair.  Will  inquire. 

Finances  Nov.  23,  '15.  Letter  from  Mrs.  Peters, 
Xenia.  Encloses  $24.50  for  Clarence's  board.  See 
Expense  Sheet.  Has  heard  that  Clarence's  uncle  in 
New  Jersey  is  superintendent  in  a  large  factory  and 
should  pay  Clarence's  board.  If  he  won't,  Mrs.  P. 
will  continue  efforts  to  raise  the  money. 

Conduct  Dec.  14,  '15.  Letter  from  Mrs.  S.,  foster 
mother.  Clarence's  improvement  continues.  May  he 
go  home  for  Christmas? 

165 


THE  SOCIAL  CASE  HISTORY 

TREATMENT  RECORD 

Deserted  woman,  two  daughters  and  one  son  by  previous 
marriage,  the  eldest  married. 

Health — Jessie  Nov.  13,  '12  (F.  S.).  Miss  Smith  re- 
ported Jessie  (youngest)  examined  at  Farnsworth 
Hospital.  Case  of  acute  chorea;  not  advisable  to 
remove  tonsils  at  present;  heart  affected.  Will  keep 
Jessie  three  or  four  weeks. 

Home  condition  Nov.  14,  '12  (M.  A.  V.)  called.  Mrs. 
W.  at  home  alone;  had  just  finished  lunch;  room  very 
warm,  clothes  boiling  on  stove.  Mrs.  W.  said  Jessie 
reluctantly  went  with  Miss  Smith.  Had  letter  from 
Miss  Smith  saying  Jessie  would  be  in  hospital  three  or 
four  weeks,  and  then  convalescent  care  would  be  pro- 
cured for  her,  if  possible.  Asked  Mrs.  W.  to  bring 
Harry  to  Van  Zandt  Dispensary  soon. 

Health  and  Conduct — Son-in-Law  She  thought  Mr. 
Richards  (her  daughter  Annie's  husband)  was  ex- 
amined at  Consumptive  Hospital;  was  told  to  return 
on  the  1 5th.  Mr.  R.  has  treated  Mrs.  W.  badly; 
while  under  the  influence  of  drink  became  angry  and 
struck  her.  Mrs.  W.  has  no  use  for  him.  Thought 
him  "so  nice"  before  they  were  married;  now  regrets 
marriage. 

Family  relationship  Mrs.  W.  said  she  would  like  to 
reach  Mr.  W.  (her  second  husband)  for  she  thinks  he 
would  return  to  her,  and  she  needs  the  additional 
money.  Says  Mr.  W.  is  a  good  man,  has  good  prin- 

166 


THE  NARRATIVE  IN  DETAIL 

ciples,  only  Annie  and  Harry  could  not  get  along  with 
him.  Thinks  Jessie  of  different  disposition  and  would 
be  happy  with  Mr.  W.  Harry  could  stay  at  Annie's 
house  if  friction  recurred. 

Whereabouts  of  second  husband  Mr.  W.  was  married 
first  time  in  Peoria,  then  went  to  Chicago;  had  six 
children,  five  of  whom  died.  When  Mr.  W.  married 
Mrs.  W.,  his  son,  a  boy  of  fourteen,  was  living  with  an 
aunt  and  working  at  Rosenbaum's  Department  Store. 
Thinks  perhaps  Mr.  W.  can  be  reached  through  this 
information. 

Health— Jessie  Nov.  20,  '12  (M.  A.  V.)  Telephoned 
Farnsworth  Hospital,  Social  Service  Department. 
Jessie  is  having  every  care  and  is  contented.  Should 
have  convalescent  care  after  she  leaves  hospital,  if 
home  conditions  are  not  good.  Suggesting  Mountain 
View  House,  family  agency  paying  board. 

Son-in-law,  Finance,  Health  Nov.  20,  '12  (M.  A.  V.) 
Saw  Mrs.  Richards,  who  said  Mr.  R.  had  made  out 
application  for  compensation  from  the  Government. 
Mr.  R.  was  examined  at  Consumptive  Hospital  and 
told  that  he  is  in  no  condition  to  work.  Has  active  tb. 
and  will  go  away  if,  after  examination  on  the  25th,  it 
is  considered  necessary. 

Health— Jessie  and  Harry  Mrs.  R.  says  Jessie  is  having 
splendid  care  at  hospital  and  is  contented  and  happy. 
Harry  has  been  examined  at  Van  Zandt  Dispensary, 
has  tonsillitis  and  is  to  return  for  further  examination 
on  the  25th. 

167 


THE  SOCIAL  CASE  HISTORY 

Suggestions  for  clarifying  them. — In  order  to 
clarify  the  treatment  record  by  making  the  more 
important  of  the  various  subjects  of  discourse 
stand  out  from  the  less  important,  the  writer 
offers  three  suggestions: 

First,  that  diagnostic  summaries  be  made  not 
only  when  investigation  is  reasonably  complete 
but  at  the  close  of  each  episode  or  phase*  of  treat- 
ment. Social  workers  recognize  that  when,  as  is 
often  the  case,  the  client's  need  extends  over 
many  months  or  even  years,  his  situation  is  likely 
to  show  a  succession  of  phases,  each  calling  for  a 
diagnosis  somewhat  different  from  the  one  pre- 
vious. This  brings  it  about  that  in  a  long-con- 
tinued case  problem,  it  is  a  question  not  of  get- 
ting at  one  ' 'constellation  of  meanings/1  or  diag- 
nosis, for  good  and  all,  but  rather  of  modifying 
the  diagnostic  summary  from  time  to  time.  Not 

*  A  "phase"  may  represent  some  one  especially  impor- 
tant treatment  act  which  alters  the  problem,  like  the  re- 
moval of  children  from  their  parents,  or  the  getting  a 
patient  into  a  hospital,  or  it  may  represent  some  signi- 
ficant incident  in  the  client's  life  which  will  change  his 
situation;  e.  g.,  the  inheritance  of  a  few  hundred  dollars, 
the  death  of  the  wife  and  mother. 

1 68 


THE  NARRATIVE  IN  DETAIL 

only  may  the  circumstances  of  the  client  change 
in  the  course  of  events — that  goes  without  saying 
— but  the  action  which  the  social  case  worker 
follows  in  the  first  instance  may  become  a  causa- 
tive factor  in  the  succeeding  phase.  For  example, 
the  first  three  phases  in  a  successfully  treated 
family  whose  need  lasted  several  years  show  the 
following  changes  in  diagnostic  summary: 

FACTORS  IN  ROBERTSON  CASE 

James        33                      Margaret  9 

Mary         30                     Ethel  7 

Garrett  4 

I. 

MAN.    I. 

A.  Inconclusive  Heredity:  his  father  said  (by  sister-in-law) 
to  have  died  a  hopeless  drunkard. 

B.  Physical  Development.    No  information. 

C.  Mental  Development.   Unstable?  (No  examination — 
a  layman's  query.) 

II. 

A.  Family.  Selfish  and  irresponsible  husband  and  father: 
extreme  groundless  jealousy  of  wife;  threatens  to  take 
children  from  her;  talks  coarsely  before  children  at 
times;  has  never  supported  family;  dresses  well  when 
children  hungry  on  plea  he  must  in  order  to  get  work; 
children  sometimes  underfed  and  poorly  clad;  no 
settled  home. 

169 


THE  SOCIAL  CASE  HISTORY 

B.  Sex.    Irresponsible  sex  conduct.     Marriage  forced  by 
woman's  family. 

C.  Occupation.     Doubtful    employ  ability:    suspicion    of 
dishonesty;  overbearing  disposition  (wants  to  be  boss, 
can't  take  orders);    laziness;    can  earn  good  money 
"when  he  feels  like  it"  (according  to  brother-in-law). 

D.  Recreation ? 

E.  Religion ? 

F.  Rehabilitation—      — ? 

WIFE.    I. 

A.  Stable  Heredity  (so  far  as  known);   relatives  all  self- 
respecting  and  self-supporting. 

B.  Physical  Development  normal:  has  good  health. 

C.  Mental  Development  good:    intelligent  woman  ac- 
cording to  former  employers  and  social  worker. 

II. 

A.  Family.    Conscientious  wife:  left  man  a  year  ago  when 
home  had  to  be  broken  up  and  children  placed  because 
of  no  support;  returned  in  a  few  days  because  thought 
it  her  duty.     Responsible  and  anxious  mother:   appar- 
ently now  determined  to  separate  from  man  for  chil- 
dren's sake;  worried  over  his  influence  on  children  and 
over  his  threats;  children  have  good  health  and  careful 
training;  woman  worked  occasionally  to  get  food  for 
children.    Cohesive  family:  relatives  ready  to  help  so 
far  as  able. 

B.  Sex.    Indiscretion:    early  marriage  forced,   in  love 
with  man. 

C.  Occupation.    Reliable,  unskilled  worker:  wage-earner 

170 


THE  NARRATIVE  IN  DETAIL 

on  leaving  grammar  school;  cleaning- woman  and 
amateur  dressmaker;  upright  and  industrious  (accord- 
ing to  employers  and  social  worker).  Kept  as  good  a 
home  as  uncertain  income  permitted. 

D.  Recreation ? 

E.  Religion.     Loyal  churchwoman.     Careful  about  chil- 
dren's religious  training. 

F.  Rehabilitation.     Treatment   for    long-continued    and 
aggravated  non-support:    church  and  relief  agency  in- 
terested to  assist ;  no  savings  or  income. 

Plan:  To  further  legal  separation. 

II. 
WOMAN.    I. 

A.  Heredity— as  above. 

B.  Physical  Development — unchanged. 

C.  Mental  Development — unchanged. 

II. 

A.  Family 

Broken  yet  secure  home:  LEGAL  SEPARATION  FROM  MAN. 
Responsible  mother:  man's  imprisonment  (for  larceny) 
relieving  woman  of  worry  lest  he  take  children. 

B.  Sex—        — ? 

C.  Occupation.     Vocational  handicap:  slight  education; 
lack  of  vocational  training;    mere   knack  at   dress- 
making;   scarcity  of  regular  half -skilled  or  unskilled 
work  within  hours  allowing  of  care  for  children. 

D.  Recreation ? 

E.  Religion as  above. 

F.  Rehabilitation.     Treatment  for  dependent  but  reliable 

171 


THE  SOCIAL  CASE  HISTORY 

mother:  continuing  interest  of  church  and  relief  agency ; 
relatives  unable  to  help  further;  no  savings  or  income. 
Plan:  To  raise  an  allowance. 

III. 
WOMAN.    I. 

A.  Heredity — as  above. 

B.  Physical  Development — unchanged. 

C.  Mental  Development — unchanged. 

II. 

A.  Family.    Blameless  partial  neglect  of  children:    ir- 
regular or  hurried  feeding  of  children  at  times;    in- 
sufficient oversight  (because  of  demands  of  work). 

B.  Sex ? 

C.  Occupation.    Good  vocational  promise:   ambition  for 
self-support;    certified   knack   at   dressmaking:    dis- 
couraged conviction  she  can  never  support  children  by 
unskilled  dressmaking  or  by  cleaning,  and  anxiety  over 
uncertainty    of    income;     scanty    education    due    to 
necessity  for  earning  on  leaving  grammar  school,  to 
lack  of  opportunity  in  native  village,  and  to  early 
marriage. 

D.  Recreation ? 

E.  Religion unchanged. 

F.  Rehabilitation.     Treatment  for  dependent  mother  in 
need  of  vocational  training:   ALLOWANCE  HAS  PROVED 

SUFFICIENT,  WITH  SOME  EARNINGS,  TO  INSURE  HEALTH 
AND  DECENCY  BUT  NOT  TO  PREVENT  CONSTANT  ANXIETY 

IN  A  PROVIDENT  WOMAN;  interest  of  certain  individuals 
in  giving  woman  opportunity  of  training;  co-operation 

172 


THE  NARRATIVE  IN  DETAIL 

of  public  agency  in  placing  children  where  mother  could 
visit  them  during  training  period. 
Plan:  To  give  woman  training  as  dressmaker;  children 
to  be  boarded  by  public  agency. 

The  capitalized  passages  in  Diagnoses  II  and  III 
show  in  each  instance  the  previous  action  of  the 
agency  which  has  become  a  causative  factor,  here 
phrased  as  a  concept  entering  into  its  succeeding 
diagnosis.  In  this  family  difficulty,  the  general 
description  of  which  is  "non-support,"  the  legal 
separation  furthered  by  the  agency  at  the  wo- 
man's wish  marked  the  end  of  the  first  phase  of 
treatment,  and  radically  changed  the  nature  of 
the  social  problem.  We  are  now  dealing  no  longer 
with  a  non-support  problem,  but  with  a  depen- 
dent mother  one.  This  changes  the  main  concepts 
in  the  case  from  "selfish  husband  and  father," 
"doubtful  employability,"  "conscientious  wife," 
"reliable  unskilled  worker,"  "treatment  for  ag- 
gravated non-support,"  to  "broken  yet  secure 
home,"  "vocational  handicap,"  and  "treatment 
for  dependent  and  reliable  mother."  The  situa- 
tion now  turns  on  the  woman's  qualifications  as 
breadwinner,  instead  of  on  the  man's.  In  the 
173 


THE  SOCIAL  CASE  HISTORY 

third  phase  the  woman  asks  for  training,  and  the 
concepts  making  up  the  diagnosis  are  "blameless 
partial  neglect  of  children,"  "vocational  prom- 
ise," and  "treatment  for  dependent  mother  in 
need  of  vocational  training."  One  of  the  factors 
which  plays  a  part  in  her  discouragement  and  her 
desire  for  vocational  opportunity  is  the  amount 
of  the  allowance  secured  by  social  agencies.  The 
two  main  treatment  acts  of  the  agency  in  charge 
were  then,  first,  to  help  the  woman  secure  legal 
separation;  second,  to  raise  an  allowance  for  her 
which  she  had  to  supplement  with  uncertain 
earnings.  It  is  evident  that  treatment  in  both  in- 
stances vitally  affected  the  client's  situation  and 
therefore  affected  the  diagnosis. 

The  same  thing  would  be  true  in  a  child  welfare 
case  in  which  the  children  were  first  removed 
from  neglectful  parents  and  then  were  boarded 
out.  The  removal  from  the  parents  becomes  a 
causative  factor  necessitating  a  substitute  home, 
and  bringing  to  light  other  problems,  such  as  that 
of  training  a  child  with  inherited  peculiarities  of 
temperament.  Does  this  not  point  out  clearly 
what  we  have  all  more  or  less  recognized,  that 
174 


THE  NARRATIVE  IN  DETAIL 

since  an  agency's  action  in  a  client's  situation 
operates  in  varying  degrees  actually  to  change 
the  nature  of  his  problem,  therefore,  once  having 
interfered  in  his  life,  we  are  under  an  obligation 
to  see  him  through  his  troubles  to  the  extent  of 
Durability? 

These  summaries,  made  at  turning  points  in 
the  client's  story,  would  not  only  supply  a  con- 
necting link  between  the  succession  of  events  re- 
corded, showing  the  purposefulness  of  treatment 
that  underlies  their  apparent  disconnection,  but 
would,  by  revealing  any  lack ;  in  clear  purpose, 
tend  to  make  a  conscientious  wiorker  stop  and  do 
the  thinking  she  has  neglected  \to  do  before. 

The  second  suggestion  for  clarifying  the  treat- 
ment record  is  that  in  any  entry  the  most  impor- 
tant matter  be  placed  at  the  beginning  of  the 
paragraph  where  it  will  catch  the  eye  of  the 
reader  most  readily.*  Whereas  in  ordinary  writ- 
ing the  last  sentence  of  a  paragraph  is  equally 
conspicuous  with  the  first,  in  record  writing, 

*  Needless  to  say,  should  all  the  facts  to  be  entered  from 
one  interview  be  of  apparently  equal  importance  this 
suggestion  would  not  apply. 

175 


THE  SOCIAL  CASE  HISTORY 

where  the  paragraphs  begin  with  the  date  and 
the  source  of  information  (facts  which  since  they 
affect  all  that  follows  the  reader  must  look  at 
first  anyway),  the  beginning  of  a  paragraph  is 
more  conspicuous  than  the  end.  Therefore,  by 
finding  the  most  important  fact  in  each  para- 
graph at  the  beginning,  the  reader  will  not  only 
get  leading  points  more  clearly,  but  should  he 
wish  to  recur  to  any  special  fact  of  importance, 
he  can  run  down  the  length  of  a  page  more 
quickly. 

The  third  suggestion  is  that  marginal  signs  be 
used  to  call  attention  to  facts  of  special  impor- 
tance to  the  problem  under  care.  Since  the  sig- 
nificance of  entries  in  a  record  is  always  a  ques- 
tion of  degree,  we  can  recognize  certain  ones  even 
among  the  important  facts  in  any  history  as 
making  more  difference  to  successful  treatment 
of  the  case  in  question  than  do  others.  The 
worker  could  bring  such  facts  into  the  foreground 
by  indicating  in  the  margin  those  items  in  the 
treatment  record  which  show  changes  in  or  devel- 
opment of  the  causal  factors  as  given  in  the  diag- 
nostic summary.  In  the  treatment  following 
Summary  I,  p.  169,  the  facts  to  be  thus  made  to 
176 


THE  NARRATIVE  IN  DETAIL 

stand  out  would  have  been  the  mother's  lack  of 
vocational  training,  knack  at  dressmaking,  the 
scarcity  of  work  she  was  fitted  for,  and  the  ina- 
bility of  relatives  to  continue  help;  in  the  treat- 
ment following  Summary  II  the  facts  to  be  noted 
would  have  been  the  woman's  vocational  dis- 
couragement and  the  reason  for  it,  her  worry  in 
spite  of  the  allowance,  her  partial  neglect  of  the 
children  and  its  explanation.*  These  facts  all 
represent  changes  which  have  appeared  in  the 
causal  factors  in  the  problem.  In  medical  social 
cases,  although  the  treatment  record  would  al- 
ways emphasize  health,  there  would  be  certain 
social  facts  which  might  be  marginally  noted  be- 
cause so  closely  related  to  health  as  to  carry  equal 
significance  for  successful  dealing  with  the  pa- 
tient; e.g.,  anything  in  the  patient's  tempera- 
ment or  circumstances  that  stood  in  the  way  of 
his  carrying  out  the  physician's  directions. 

*The  interest  of  certain  individuals  in  financing  this 
mother's  training  and  the  co-operation  of  the  public 
agency  in  placing  the  children,  being  parts  of  the  treat- 
ment process  the  importance  of  which,  although  great,  is 
temporary,  should  not  be  made  conspicuous  by  any  mar- 
ginal sign. 

12 


THE  SOCIAL  CASE  HISTORY 

These  important  or  significant  facts  noted  in 
the  margin  will  often  be  one  with  evidence  as  to 
the  client's  social  relationships.  Since  these  rela- 
tionships are  the  special  field  of  the  social  worker, 
and  since  it  is  in  these  contacts  that  an  individual 
develops  and  reveals  personality,  emphasizing 
facts  of  personality  in  the  record  would  empha- 
size that  part  of  the  social  worker's  function 
which  calls  for  most  insight  and  skill.  Concepts 
indicating  temperament,  character,  personality 
will  appear  constantly  among  the  causal  factors 
in  the  diagnosis  of  social  case  work  problems. 
Therefore  the  worker  who  wishes  to  give  promi- 
nence to  the  especially  significant  treatment 
entries  will  often  find  herself  putting  a  marginal 
sign  opposite  facts  which  indicate  personality* 
This  would  be  true  in  spite  of  the  fact  that  our 
work  at  present  is  primarily  with  income,  with 
the  securing  of  hospital  care,  employment,  voca- 
tional guidance.  As  Mary  C.  Jarrett  has  re- 
marked : 

"So  far  social  case  work  has  dealt  mainly  with  the  ele- 
mentary facts  of  social  adjustment:  income,  employ- 
ment, housing,  housekeeping;  and  with  the  primary 

178 


THE  NARRATIVE  IN  DETAIL 

social  problems:  how  to  find  a  job,  to  bring  a  deserting 
husband  from  another  state,  to  get  milk  for  the  baby, 
convalescent  care  for  the  sick,  to  move  a  family  to  a  better 
house  .  .  .  We  see  case  work  about  to  pass  into  a 
psychological  phase  .  .  .  No  one  will  be  able  to  say 
when  or  where  factors  of  personality  rather  than  factors 
of  environment  began  to  be  the  dominant  influence  in 
social  case  work.  It  is  clear  that  environment  prevails  at 
present.  It  is  becoming  evident  that  personality  will 
become  the  leading  interest  in  the  future."  * 

In  thinking  of  personality  as  the  center  of  con- 
cern in  social  case  work,  does  not  Miss  Jarrett 
mean  personality  as  identified  by  its  response  to 
the  complex  social  environment  of  modern  life, 
and  as  developed  and  expressed  through  its  vari- 
ous social  contacts? 

In  any  study  of  personality  as  identified  by  its 
response  to  environment  social  workers  must 
necessarily  follow  behind  the  psychologists.  Al- 
though the  latter  have  got  but  a  short  way  on  the 
road  toward  a  "science  of  character,"  social  work- 
ers could  apply  whatever  knowledge  is  as  yet 
available.  It  would  be  a  beginning  toward  this  if 

*"  Psychiatric  Social  Work,"  p.  287,  in  Mental  Hygiene, 
April,  1918. 

179 


THE  SOCIAL  CASE  HISTORY 

we  were  to  identify  and  report  such  ascertained 
marks  of  personality  as  disclose  themselves  in 
connection  with  the  elementary  facts  of  social 
adjustment. 

"Color"  in  the  Record. — It  is  mainly  the  de- 
picting of  a  client's  personality  which  workers 
have  in  mind  when  they  speak  of  putting  ' 'color" 
into  records.  By  color  they  mean  an  individual- 
izing of  a  client  by  recording  such  incidents  about 
him  as  will  make  him  seem  a  living  person  and 
not  a  marionette.  Records  in  which  the  clients 
might  be  interchanged  without  apparently  alter- 
ing the  problem  of  either  will  occur  to  anyone 
familiar  with  these  social  documents.  Two  de- 
serted women  may  be  distinguishable  from  each 
other  not  by  any  hint  as  to  their  traits  of  char- 
acter, but  by  the  fact  that  one  has  five  children 
and  the  other  three;  one  is  robust,  the  other 
fragile;  one  Polish,  the  other  French  Canadian. 
Two  husbands  may  differ  only  as  to  their  age, 
birthplace,  and  the  names  of  their  employers. 
This  may  answer  all  practical  requirements  if 
what  the  worker  needs  to  do  for  these  clients  is 
merely  the  raising  of  allowances  for  the  women 
1 80 


THE  NARRATIVE  IN  DETAIL 

and  the  directing  of  the  men  to  jobs.  Having 
satisfied  herself  that  the  women  are  respectable 
and  are  reasonably  good  mothers  and  that  the 
men  are  honest  and  sober,  she  can  pass  on  to 
treatment. 

Normal  and  abnormal  traits. — The  social  worker 
has  to  deal  right  along  with  a  certain  number  of 
clients  whose  situations  call  for  the  use  of  only 
"the  elementary  facts  of  social  adjustment:  in- 
come, employment,  housing,  house-keeping." 
These  are  fairly  normal  people  whose  problems 
are  not  complicated  by  any  pronounced  inadapt- 
ability of  character.  The  adjusting  of  their  diffi- 
culties may  not  be  easy,  but  it  can  often  be  done 
satisfactorily  with  the  extreme  minimum  of  char- 
acter insight.  The  moment  the  worker  finds  a 
need  of  influencing  the  conduct  or  the  decisions 
of  her  clients,  she  must  get  at  an  understanding 
of  their  inner  life.  At  present,  character  study 
which  is  sufficiently  formulated  to  be  reflected  in 
records  is  to  be  met  with  mainly  in  the  case  of 
clients  who  are  something  other  than  what  we 
call  normal.  In  this  early  stage  of  "characterol- 
ogy"  the  observing  of  exaggerated  and  unorgan- 
181 


THE  SOCIAL  CASE  HISTORY 

ized  traits  is  not  only  easier  than  the  study  of 
"normal'*  persons  but  it  affords  a  fruitful  method 
for  getting  light  upon  normal  human  personality.* 
Relevant  and  irrelevant  "color." — A  method  by 
which  social  case  workers  sometimes  attempt  to 
individualize  a  client  is  to  give  a  short  description 
of  his  appearance;  "a  heavy-set  man" ;  "a  short, 
spare  woman";  "she  wears  her  hair  in  gray 
puffs";  "little  freckle-faced  boy."  In  estimating 
the  value  of  such  description  we  must  bear  in 
mind  that  workers  are  writing  their  records  not 
for  the  entertainment  of  drama  seekers,  but  to 
further  social  case  treatment.  Any  fact  which 
does  not  advance  this  purpose  is  out  of  place,  in- 
appropriate, drawing  both  the  reader's  and  the 
case  worker's  attention  away  from  the  problem. 
Is  treatment  ordinarily  furthered  by  the  knowl- 
edge that  a  woman  is  short?  Should  we  do  some- 

*"  Insane  conditions  have  this  advantage,  that  they 
isolate  special  factors  of  the  mental  life,  and  enable  us  to 
inspect  them  unmasked  by  their  more  usual  surroundings. 
They  play  the  part  in  mental  anatomy  which  the  scalpel 
and  the  microscope  play  in  the  anatomy  of  the  body." 
James,  William:  The  Varieties  of  Religious  Experience, 
p.  22.  Longmans,  1916. 

182 


THE  NARRATIVE  IN  DETAIL 

thing  different  if  she  were  tall?  Are  there  any 
conceivable  circumstances  in  which  gray  puffs  on 
a  woman's  head  or  freckles  on  a  child's  face 
would  alter  treatment?  These  facts  do  not  point 
to  traits  of  character,  they  do  not  suggest  per- 
sonality. Even  were  we  writing  novels  instead  of 
case  records,  a  description  which  has  no  bearing 
on  the  development  of  the  plot  would  be  out  of 
place.  "Too  frequently  the  amateur  gives  his 
people  an  inventory  of  features  merely  for  their 
own  sake — a  bright  blue  eye,  or  a  mole  on  the 
chin,  a  little  nervous  habit  of  tightening  the  neck- 
tie, or  a  slight  stammer  in  speech — without  ask- 
ing if  these  are  in  any  way  characteristic  features 
.  .  .  .  The  details  that  finally  count  for  us 
are  those  emphasizing  the  role  the  character 
plays''*  Or  again,  "If  the  appearance  of  the 
actors  (in  a  story)  has  absolutely  nothing  to  do 
with  the  reader's  interest  in  them  or  in  their  ac- 
tions, the  least  said  about  it  the  better."f  The 

*  Campbell,  O.  J.,  Jr.,  and  Rice,  R.  A.:  A  Book  of  Narra- 
tives, p.  286.  D.  C.  Heath,  1917.  Italics  not  the  au- 
thors'. 

t  Albright,  E.  M.:  Descriptive  Writing,  p.  97.  Mac- 
millan,  1911. 

183 


THE  SOCIAL  CASE  HISTORY 

social  worker's  interest  and  that  of  any  persons 
who  read  her  records  is  either  the  practical  one  of 
treatment  or  the  scientific  one  of  study.  She 
therefore  should  select  her  descriptive  facts  in 
the  light  of  this  interest. 

There  is  description,  however,  which  is  rele- 
vant to  social  case  work,  which  furthers  its  pur- 
pose. Take  these  facts  about  a  wayward  girl : 

Is  medium  height,  very  dark,  complexion  clear,  black 
hair,  glittering  eyes,  bridge  of  nose  somewhat  flattened, 
teeth  good  and  have  been  taken  care  of,  shows  evidences 
of  negro  blood.  She  laughs  constantly  and  seems  to  be 
in  excellent  spirits. 

The  evidence  of  negro  blood  with  its  bearing  on 
character  would  of  course  affect  treatment,  as 
would  also  the  girl's  good  spirits.  Indeed,  the 
appearance — face,  figure,  manner,  dress — of  any 
young  girl  or  woman  client  in  so  far  as  it  is  a 
factor  in  her  attractiveness  to  men  is  always  of 
prime  importance.  In  this  instance  the  bearing 
of  the  girl's  height  on  treatment  is  not  so  clear. 
If,  however,  she  is  a  girl  likely  to  run  away,  the 
height  would  be  relevant  for  police  identification. 
184 


THE  NARRATIVE  IN  DETAIL 

The  man,  who  is  small,  pale,  and  thin,  said  that  he  had 
been  working  as  a  laborer. 

The  man  in  this  instance  was  feeble-minded, 
therefore  his  underdeveloped  body  was  of  impor- 
tance both  as  part  of  an  industrial  handicap  and 
as  one  of  the  stigmata  of  defect. 

Her  dress,  though  patched  and  colorless,  was  clean. 

Here  is  evidence  of  personal  self-respect,  an 
important  trait  in  the  social  worker's  eyes. 

Furniture  old  but  in  good  condition,  worn-out  square 
piano  purchased  for  $5.00  years  ago,  elaborate  silver 
candelabra,  a  recent  gift  from  maternal  uncle  Joseph. 

This  points  to  family  self-respect,  a  struggling 
for  standards.  They  have  taken  care  of  their 
furniture  and  cherish  the  symbols  of  cultivation. 

A  girl  of  seventeen,  the  oldest  daughter  among  a  large 
family  of  children  whose  mother  was  feeble-minded  and 
erratic,  came  into  the  office  of  a  social  agency  to  discuss 
the  needs  of  her  younger  brothers  and  sisters.  For 
several  years  she  had  faithfully  and  unquestioningly 
carried  a  premature  responsibility  in  an  ill-kept  home. 
She  entered  the  office  "dressed  in  a  pale  pink  silk,  high- 
heeled  slippers,  her  hair  down  over  her  ears  (the  extreme 
of  fashion  so  far  as  her  small  means  would  allow),  and  in 

185 


THE  SOCIAL  CASE  HISTORY 

the  course  of  conversation  she  mentioned  that  she  wanted 
to  become  a  manicurist." 

For  one  who  would  influence  this  girl,  such  a 
description  is  highly  significant.  The  facts  quoted 
which,  taken  by  themselves,  suggest  "flyness," 
looked  at  in  the  light  of  her  devotion  to  her  fam- 
ily, indicate  what  are  some  of  the  better  things 
she  values  in  life.  Bred  in  slackness,  her  effort  at 
style  and  her  wish  to  do  manicuring  represent  a 
reaching  toward  what  to  her  seem  higher  stand- 
ards. 

The  following  succession  of  sentences  taken 
from  the  history  of  a  fairly  skilful  artisan  who  had 
got  into  heavy  debt  through  his  drinking  habits, 
seem  to  the  writer  to  show  facts  that  should  be 
made  to  stand  out  in  the  record  as  having  espe- 
cial character  significance. 

From  the  investigation  record : 

The  men  working  at  the  X have  a  great  many 

good  times  together  and  seem  to  take  debt  as  a  matter  of 
course.  Man  is  rather  proud  of  the  financial  difficulties 
which  he  has  been  through.  (Interview  with  man.) 

The  men  at  the  X —     —  are  a  sporting  crowd  inclined 
to  drink  and  many  of  them  have  to  let  their  wives  collect 
their  wages.     (Interview  with  manager.) 
186 


THE  NARRATIVE  IN  DETAIL 

He  does  not  want  to  assign  his  wages  to  his  wife  as  it 
"seems  a  kiddish  thing  to  do. "  (Interview  with  man.) 

He  is  very  fond  of  his  children  and  does  not  mean  to 
spoil  their  chances  for  an  education.  He  loves  his  wife 
and  wishes  that  he  might  have  work  in  the  daytime  so 
that  he  could  go  out  with  her  instead  of  his  companions 
at  the  X .  (Interview  with  man.) 

From  the  treatment  record  one  month  later: 

Man  is  straightforward  in  admitting  that  the  fault  has 
been  entirely  his,  and  is  quite  willing  to  let  his  wife  man- 
age his  earnings  hereafter.  He  does  not  try  to  gloss  over 
his  reasons  for  borrowing  money,  and  tells  Miss  Y. 
frankly  of  having  bought  a  watch  on  the  instalment  plan 
for  the  sake  of  pawning  it. 

Man  is  quite  ill  from  the  effects  of  the  whiskey,  and  is 
thoroughly  frightened.  He  has  to  have  a  certain  amount 
every  day  to  make  him  able  to  go  to  work. 

He  is  willing  to  see  a  doctor  but  is  not  quite  sure  that 
he  wants  to  give  up  drinking  entirely.  (Interviews  with 
man.) 

Two  years  later: 

He  thinks  that  in  different  work  he  would  have  less 
temptation,  as  the  long  night  hours  often  make  his  head 
tired  and  he  takes  a  drink  hoping  to  improve  his  condition, 
and  this  starts  one  of  his  sprees.  Is  disinclined  to  change 
his  work,  however,  as  he  sees  no  way  of  making  as  much 
money. 

187 


THE  SOCIAL  CASE  HISTORY 

This  man  finally  secured  the  same  sort  of  work 
with  a  different  firm  and  after  that  with  occa- 
sional lapses  showed  marked  improvement. 

The  above  sentences  are  significant  because 
they  appear  to  point  to  the  man's  companions  at 

the  X as  forming  a  public  opinion  for 

which  he  felt  a  regard,  a  crowd  to  whom  debt  and 
drink  went  with  being  one  of  the  boys,  a  "good 
sport."  Certain  of  Briggs'  comic  pictures  have 
made  familiar  a  higher  grade  of  this  general  type. 
While  of  course  it  was  this  man's  "personality" 
which  led  him  to  take  up  with  such  companions, 
yet  once  he  had  formed  the  connection,  these  men 
constituted  a  sort  of  moral  sounding-board  to 
exaggerate  what  was  probably  a  native  uncon- 
trol  and  irresponsibility  by  justifying  it.  This 
means  that  anyone  who  wished  to  help  such  a 
man  to  a  better  ordered  life  would  either  have  to 
induce  him  to  separate  from  the  crowd  at  the 

X ,  as  was  done,  or  would  have  to  make  the 

attempt  to  modify  the  standards,  the  values,  of 
the  crowd  as  a  whole. 

Descriptive  facts  which  show,  as  do  those  in 
this  and  in  the  three  previous  illustrations,  the 
188 


THE  NARRATIVE  IN  DETAIL 

client's  ambitions,  what  he  values,  have  an  espe- 
cial significance  in  that  they  point  to  group 
standards  in  the  background.  The  things  which 
a  man  values  in  life  are  those  which  a  number  of 
other  persons — his  crowd — values.  As  it  was 
with  the  drinking  man  and  his  sporty  fellow- 
workmen,  so  it  was  with  the  girl  of  seventeen  and 
her  friends.  She  got  her  idea  of  niceness  either 
from  her  girl  friends — a  real  social  contact — or 
from  novels,  movies — an  imaginative  contact. 
The  family  who  aimed  to  have  a  pretty  parlor 
got  this  modest  ambition  from  friends  and  rela- 
tives to  whom  that  was  an  essential  of  self-re- 
spect, a  sign  that  you  are  somebody;  the  woman 
who  washed  and  patched  her  old  clothes  was 
reflecting  and  repeating  the  standards  of  her 
parents  and  of  her  friends.  Such  description  is 
relevant  because  it  characterizes  the  client  by 
intimating  the  crowd  to  which  he  belongs — his 
social  relationships;  and  by  so  doing  it  gives  the 
social  worker  the  key  to  influence  over  him. 

Is  it  not,  on  the  other  hand,  a  misplacing  of 
emphasis  for  social  workers  to  strive  in  their 
record  writing  for  "color"  in  the  sense  of  vivid  or 
189 


THE  SOCIAL  CASE  HISTORY 

picturesque  details  of  "human"  interest?  What 
prompts  them  to  do  so  is  doubtless  the  influence 
we  are  all  under  as  readers  of  fiction — the  influ- 
ence of  a  literary  preoccupation  with  character 
for  character's  sake.  The  fiction  writer  can 
abound  in  character  detail  because  this  gives  not 
only  to  the  central  figures  in  his  story  their  mo- 
tivation but  to  the  incidental  figures  their  "truth 
to  life."  But  the  record  writer  has  a  more  re- 
stricted concern.  She  is  a  specialist,  reporting  on 
such  character  facts  as  bear  on  specific  malad- 
justments. Not  picturesqueness  but  precision  is 
what  she  should  strive  for;  not  amateur  "por- 
trayal" such  as  imputes  a  connection  between 
full  lips  and  warm  emotions,  close-set  eyes  and 
jealousy,  erect  carriage  and  pride,  but  profes- 
sional interpretation,  that  chooses  its  words  re- 
sponsibly. 

This  does  not  mean  that  the  record  writer  can 
get  no  help  from  her  fiction  reading.  The  real 
masters  of  character  portrayal,  such  as  John 
Galsworthy  and  Joseph  Conrad,  can  sensitize 
her  mind  to  the  observation  of  subtle  and  signifi- 
cant traits,  and  at  the  same  time  enrich  her 
190 


THE  NARRATIVE  IN  DETAIL 

descriptive  vocabulary.  By  learning  the  sources 
of  their  power,  she  will  find  that  her  efforts  to 
individualize  her  clients  in  the  particulars  that 
count  for  treatment  will  incidentally  achieve 
color  and  readableness  in  her  narrative. 

"Color"  and  concreteness. — In  any  attempt  to 
make  factors  of  personality  more  conspicuous  in 
a  record  the  social  case  worker  needs  to  be  on 
guard  against  merely  labeling  her  client  with 
adjectives  of  a  general  sort  without  giving  the 
facts  which  point  to  the  qualities  described.  For 
instance: 

Mary  was  winning,  affectionate,  obedient  one  day,  the 
next  capricious,  impertinent. 

What  we  need  are  a  few  illustrations  of  her  obedi- 
ence one  day  and  of  her  rudeness  the  next,  with 
the  occasions  on  which  she  displayed  such  oppo- 
site behavior.  Is  there  an  explanation  of  her 
changeableness ;  did  some  special  sort  of  treat- 
ment— abrupt  speech  or  requests  to  do  things  she 
disliked — make  her  rude,  or  was  her  impertinence 
to  be  referred  partly  to  some  physical  condition, 
fatigue  or  loss  of  sleep?  In  other  words,  we  want 
191 


THE  SOCIAL  CASE  HISTORY 

a  picture  of  Mary  responding  to  her  social  envi- 
ronment. To  continue: 

She  worked  little  either  at  school  or  at  home.    Yet  I 
think  people  loved  her. 

These  may  be  facts  so  far  as  they  go.  We  should 
like  to  know  her  standing  in  school,  and  just  what 
she  did  that  made  people  love  her  in  spite  of  con- 
stant indolence. 

She  is  not  vicious  and  has  an  ease-loving  nature. 

The  word  "vicious"  is  applied  by  some  people 
to  a  certain  range  of  wrong  acts  and  by  others  to 
the  motives  or  the  mental  imagery  that  may  be 
behind  behavior.  We  need  to  know  what  sort  of 
wrong  acts  or  wrong  thought  the  person  inter- 
viewed means  that  this  girl  would  not  be  guilty 
of.  "Ease-loving  nature"  may  mean  mere  lazi- 
ness, or  it  may  mean  the  desire  for  very  comfort- 
able conditions  to  work  in. 

The  following  is  a  description  of  a  wayward 
boy: 

His  actions  are  shocking  and  she  (his  mother)  is  con- 
stantly in  fear  he  will  get  into  trouble. 

192 


THE  NARRATIVE  IN  DETAIL     • 

"Shocking"  is  a  carelessly  used  word  which  tells 
nothing  whatever  on  which  any  action,  court  or 
otherwise,  could  be  taken.  What  were  the  boy's 
shocking  acts?  There  might  be  a  difference  of 
opinion  as  to  their  seriousness. 

The  room  was  disorderly. 

Why  not  say  the  dishes  were  unwashed  on  the 
table,  the  children's  wraps  lying  on  chairs,  the 
saucepan  on  the  floor,  and  so  on? 

She  lacks  judgment. 

Why  not  say  that  having  broken  off  the  handle  of 
the  tin  kettle,  she  brought  hammer  and  nails  to 
mend  it?  This  says  the  same  thing  convincingly 
and,  incidentally,  with  more  "color." 

She  seems  a  nice  little  woman. 

There  must  be  at  least  fifty  different  kinds  of 
nice  little  women. 

She  is  a  neat  and  clean-looking  woman. 

Important,  so  far  as  it  goes.   This  woman  prob- 
ably had  on  a  freshly  laundered  or  well-brushed 
dress,  or  her  hair  was  smooth  and  carefully  ar- 
13  193 


THE  SOCIAL  CASE  HISTORY 

ranged,  her  face  and  hands  looked  scrubbed.  A 
safe  rule  for  the  case  worker  to  follow  is  not  to 
give  general  descriptive  terms  to  more  than  she 
makes  the  reader  see,  through  specific  facts. 

As  we  have  already  remarked,  the  social 
worker  often  uses  the  word  "color"  to  mean  not 
only  the  individualizing  of  a  client  but  vividness 
in  narration.  This  latter  effect  she  sometimes 
aims  to  get  by  selecting  direct  quotations  or  little 
dramatic  incidents  to  record. 

Her  husband  owned  a  little  plaster  house  of  one  room, 
with  less  floor  space  than  there  is  in  her  present  kitchen, 
"just  right  for  husband  and  wife."  There  were  no  win- 
dows in  this  house  and  all  the  light  and  air  came  from  the 
door. 

The  quoted  phrase  brings  out  this  woman's  con- 
tentment with  small  things. 

Sept.  8,  1916.  Miss  Wimble  (Clinton  Dispensary) 
telephones  that  she  fears  that  Mr.  D.  was  mortally 
offended  on  his  visit  to  the  Dispensary  on  Sept.  2nd.  The 
doctor  who  was  on  service  there  tries  to  make  himself 
agreeable  to  his  patients  by  jollying  them  along,  and, 
expecting  to  make  a  great  hit  with  Mr.  D.,  greeted  him 
with  "What!  not  dead  yet?"  Miss  Wimble  met  John 
and  his  father  on  their  way  out.  Both  looked  pale  and 

194 


THE  NARRATIVE  IN  DETAIL 

frightened  and  said,  "We  no  come  no  more."  Miss 
Wimble  wishes  to  have  them  assured  that  if  they  will 
come  in  again,  they  will  not  have  to  see  that  same 
facetious  doctor. 

This  gives  a  more  vivid  picture  than  would  the 
following  bare  statement : 

Miss  Wimble  asks  to  have  man  and  son  John  assured 
that  if  they  will  come  to  the  Dispensary  again  they  will 
not  have  to  see  the  doctor  who  frightened  them  by 
jocosely  expressing  surprise  to  Mr.  D.  that  he  was  still 
alive. 

The  latter,  however,  answers  the  purposes  of 
treatment  just  as  well  and  is  shorter.  It  is  a  ques- 
tion whether,  tempting  as  it  is  to  repeat  enter- 
taining incidents,  it  may  not  distract  the  atten- 
tion not  only  of  the  reader  but  of  the  case  worker 
herself  from  the  social  problem  before  her.  The 
worker  needs  to  make  sure  that  the  incident  to 
which  she  thus  gives  emphasis  is  one  which 
throws  a  corresponding  degree  of  light  upon  the 
problem  under  treatment.  The  incident  above 
should  certainly  be  recorded.  The  query  is 
whether  it  is  important  enough  to  merit  this  pic- 
turesque but  rather  full  account.  While  we  thus 
195 


THE  SOCIAL  CASE  HISTORY 

see  the  client  responding  to  his  social  environ- 
ment, it  is  a  response  which  has  but  temporary 
significance  for  treatment. 

If  the  revised  entry  were  changed  to  read 

Miss  Wimble  asks  to  have  man  and  son  John  assured 
that  if  they  will  come  to  the  Dispensary  again  they  will 
not  have  to  see  the  doctor  who  frightened  them  by 
jocosely  greeting  Mr.  D.  with  "What!  not  dead  yet?" 

the  incident  would  be  as  dramatically  recorded 
as  its  significance  deserves. 

A  worker  with  keen  sympathies  may  be  led  to 
break  the  thread  of  her  narrative  by  telling  of  the 
cunning  remark  of  a  little  girl  about  her  experi- 
ences on  country  week,  or  the  conscientiousness 
of  a  boy  in  insisting  that  his  parents  write  a  note 
to  his  teacher  when  he  is  absent  from  school,  or 
a  description  of  some  odd  Christmas  present 
which  a  client  made  for  the  worker  with  his  own 
hands.  If  these  facts  throw  such  light  upon  char- 
acter as  will  make  a  difference  in  treating  the 
client's  difficulties  they  should  be  recorded;  if 
not,  then  they  may  still  be  kept  in  a  note  book  to 
serve  in  interesting  a  committee  or  as  illustra- 
tions in  an  annual  report. 
196 


THE  NARRATIVE  IN  DETAIL 

As  a  student  of  her  case  the  worker  will  of 
course  see  that  the  incidents  and  remarks  she 
records  are  not  so  much  those  displaying  char- 
acter-war^, which  stir  approval  or  disapproval, 
as  those  displaying  character-/0rces,  which  affect 
the  client's  response  to  treatment.  It  should  be 
on  record,  for  example,  whether  the  client's 
energy  seems  constant  or  fitful,  purposeful  or 
chance-directed;  whether  his  prevailing  mood 
seems  of  an  energizing  kind — hopeful,  cheery, 
and  so  on,  or  of  a  depressive  kind — apprehensive, 
sullen;  whether  his  attitude  toward  circum- 
stances seems  active  and  resistant  or  merely  pas- 
sive; whether  in  his  social  contacts  he  seems 
assertive,  affable,  conformative,  suggestible,  or 
aloof.* 

To  carry  out  the  suggestions  in  the  two  fore- 
going chapters  means  considerable  thought  be- 
fore dictating.  This  the  worker  can  best  insure 
by  jotting  down  notes,  in  pencil  if  preferred,  but 
with  enough  fullness  to  recart  all  she  needs,  im- 

*  The  author  has  profited  by  an  unpublished  statement 
on  this  matter  by  Dr.  Abraham  Myerson,  of  the  Boston 
City  Hospital. 

197 


THE  SOCIAL  CASE  HISTORY 

mediately  after  interviews,  while  the  information 
is  fresh  in  mind.  The  temporary  sheets  may  be 
kept  with  the  permanent  record  or,  as  in  the  case 
of  one  agency,  in  a  loose-leaf  alphabetized  paste- 
board folder.  Then  before  dictating,  at  the  end 
of  a  week,  say,  she  goes  over  these  notes  in  order 
to  select  for  emphasis  the  most  important  facts 
and  to  omit  or  to  place  subordinately  those  of 
minor  significance.  This  procedure  enables  her 
to  cut  out  all  data  of  ephemeral  importance,  such 
as  the  process  of  getting  patients  to  hospitals, 
leaving  them  for  a  day  book  or  separate  sheet; 
sometimes  to  combine  matter  secured  in  two 
interviews  into  one  entry;  sometimes,  if  she 
wishes,  to  organize  an  investigation  topically. 
Upon  completing  the  dictation,  she  destroys  the 
temporary  sheets. 

Although  such  a  procedure  takes  more  time 
than  the  usual  unorganized  dictation,  with  prac- 
tice, its  selection  and  analysis  will  become  a  habit 
and  will  be  done  readily.  Moreover,  on  the 
ground  of  the  time  required,  the  objection  is  off- 
set by  the  advantage  expressed  in  the  frequent 
remark,  "It  makes  us  think  so  much  better." 


THE  NARRATIVE  IN  DETAIL 

The  effort  to  distinguish  between  important  and 
less  important  features  conduces  to  an  arrival 
with  more  certainty  at  the  meaning  or  diagnosis 
of  the  facts,  and  hence  to  surer  if  not  quicker 
treatment  of  the  client's  difficulty.  The  writer 
believes  that  if  more  workers  were  thinking  in 
the  directions  she  has  tried  to  indicate  in  this 
book,  they  would  bring  about  case  treatment  of 
so  much  greater  effectiveness  that  the  added  time 
they  spent  upon  analyses  would  be  forgotten. 

For  workers  accustomed  to  the  old  ways  of 
keeping  records,  this  careful  selection  and  arrange- 
ment of  facts  at  first  comes  hard.  It  undoubtedly 
costs  an  experienced  person  some  effort  to  change 
her  habits  under  daily  pressure  of  work.  Begin- 
ners, however,  have  the  advantage  of  learning 
from  the  first  to  treat  their  records  not  as  mem- 
oranda but  as  an  expression  of  responsible  think- 
ing about  their  client's  needs. 


199 


VII 

THE  WIDER  IMPLICATIONS  OF  CASE 
RECORDING 

/TSHE  range  of  thought  canvassed  by  the  social 
•*•  worker  comprises  concepts  which  she  is  en- 
gaged in  focussing  upon  specific  needs  of  her 
Clients,  but  which,  if  she  takes  her  work  profes- 
sionally, should  draw  her  thought  ever  outwards 
in  an  endeavor  to  chart  the  field  of  social  signifi- 
cance. These  concepts,  inevitably  complex,  she 
must  clarify  as  to  the  factors  which  make  them 
up,  if  she  is  to  attain  insight  and  perspective  in 
envisaging  her  client's  needs.  Her  mind,  as  it 
grows  cognizant  of  recurring  factors  in  the  prob- 
lems she  thinks  out,  becomes  sensitized  in  the 
presence  of  her  clients  to  facts  that  carry  treat- 
ment implications.  When  a  worker  now  says  that 
she  finds  it  impossible  to  judge  which  of  the  facts 
secured  in  an  interview  she  should  record  as  likely 
to  guide  treatment,  she  unwittingly  admits  that 
her  social  concepts  are  unanalyzed  and  vague- 
200 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

This  state  of  mind  is  not  necessarily  to  be  im- 
puted to  the  case  worker's  discredit.  It  means 
simply  that  her  profession  is  one  with  much  theo- 
retical development  ahead. 

The  client's  social  context  a  web  of  relationships. 
—The  concepts  which  the  worker  should  aim  to 
clarify  are  first  those  of  the  various  social  rela- 
tionships which  a  man  or  woman  enters  into  in 
the  course  of  his  life;  namely,  relations  with  fam- 
ily, neighbors,  fellow- workmen,  fellow-members 
in  associative  bodies  of  one  sort  or  another.  What 
qualities  of  his  character  find  play  within  each 
of  these  relationships?  What  sources  of  friction 
or  disruption  recur  within  each?  What  ideal 
values  do  each  conserve?  These  questions,  in- 
deed, focus  the  primary  concern  of  social  case 
work.  This  has  been  to  some  extent  recognized 
in  our  practice  for  many  years.  Take  the  illus- 
tration on  p.  209.  Any  trained  worker  without 
giving  thought  would  try  to  learn  more  about  the 
relations  of  Mr.  R.,  the  drunkard,  as  husband 
and  father,  as  fellow-employee,  as  citizen;  and 
about  the  physically  delicate  Mrs.  R.'s  relation 
with  her  children.  A  worker,  however,  who  had 

2OI 


THE  SOCIAL  CASE  HISTORY 

been  following  the  development  of  psychiatric 
social  work  and  who  was  therefore  equipped  to 
get  at  a  clearer  conception  of  these  relationships 
would  conduct  her  inquiries  in  a  much  more 
searching  way  than  would  the  former.  That 
these  social  contacts  constitute  the  worker's 
special  field  of  interest  is  obscured  by  the  fact 
that  appeal  for  help  from  social  agencies,  as  in 
the  family  cited  above,  is  often  made  on  the 
ground  of  economic  or  medical  rather  than  social 
need.  Lack  of  food  or  clothing  or  medical  appli- 
ance— an  inadequate  income,  in  short — pro- 
longed or  frequent  unemployment,  the  need  of 
continued  oversight  of  health,  are  not  accurately 
describable  as  "social"  wants.  Nevertheless  the 
case  worker  necessarily  includes  them  as  a  part 
of  her  field  of  interest,  since  these  disabilities  bear 
a  close  and  constant  causal  relation  to  needs  that 
are  social.  An  urgent  need  of  food,  for  instance, 
means  an  un-normal  relation  between  the  client 
and  the  public,  springing  perhaps  from  a  corre- 
spondingly disturbed  family  situation,  as  in  wid- 
owhood or  non-support.  Prolonged  or  frequent 
unemployment  affects  both  a  man's  relation  to 
202 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

the  public  and  to  his  home  (as  with  the  R.  fam- 
ily). The  continued  oversight  of  health,  in  itself 
medical  care,  may  involve  the  modifying  of  a 
parent's  or  brother's  or  wife's  attitude  toward  the 
patient  or  the  patient's  attitude  toward  employ- 
ers or  friends.  In  the  case  of  many  mental  or 
nervous  disorders,  a  psychoneurotic  condition, 
for  instance,  although  they  are  primarily  medical 
problems,  their  social  manifestations  are  so  much 
a  part  of  the  disease  that  probably  even  the 
medical  fraternity  would  be  giving  them  scant 
attention  were  it  not  for  these  non-medical  as- 
pects. If  a  psychoneurotic  or  a  mental  defective 
were  as  good  a  husband,  father,  employee,  com- 
panion, and  citizen  as  a  healthy-minded  or  an 
able  man,  his  very  identification  as  such  would 
be  gone.  Indeed,  it  is  apt  to  be  the  social  incon- 
venience or  interruption  of  sickness  that  brings 
any  physical  ill  whatever  to  notice.  Few  would 
bother  to  go  to  the  doctor  if  we  could  work  and 
play  and  get  along  with  other  people  just  as  well 
without,  and  an  important  part  of  the  improve- 
ment in  general  health  must  come  from  the 
training  of  people  to  give  early  heed  to  what 
203 


THE  SOCIAL  CASE  HISTORY 

might  be  termed  the  socio-medical  symptoms  of 
illness — disinclination  toward  effort,  a  lack  of 
zest,  development  of  irritability,  and  so  on.  In 
other  words,  whatever  the  ostensible  reason  for 
appeal,  some  maladjustment  in  one  or  another 
of  the  social  relations  is  what  brings  most  of  the 
applications  to  children's  and  family  agencies  or 
to  probation  service;  a  maladjustment  involving 
the  inter-relation  between  health  and  one  or  more 
of  a  patient's  social  contacts  is  of  course  what 
brings  applications  to  medical  social  service. 

The  worker's  competence  as  interpreter  of  social 
relations. — The  worker,  then,  to  begin  with,  needs 
to  have  in  her  mind  concepts  as  to  what  these 
different  relations  should  be — a  social  philoso- 
phy, in  short.  It  will  make  a  difference  in  the 
advice  she  gives  young  girls  and  boys,  for  in- 
stance, whether  she  inclines  to  the  patriarchal 
view  as  to  a  child's  obligations  toward  parents, 
or  whether  she  reasons  that,  as  parents  give  life 
unasked  and  in  pursuit  of  their  own  personal 
happiness,  the  obligation  is  mainly  on  their  side. 
Again,  her  notion  of  the  relation  between  the 

204 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

individual  citizen  and  the  state  will  affect  her 
action  in  the  dispensing  or  in  the  procuring  of 
outdoor  relief  for  a  client.  Whether  the  visitor 
represents  to  a  widow  that  the  public  aid  she 
asks  is  her  right,  entailing  only  a  return  on  her 
part  in  such  a  use  of  the  money  as  will  make  for 
good  citizenship  in  her  children,  or  whether  she 
makes  the  client  feel  that  public  relief  is  shame- 
ful, a  last  resort  of  despair,  her  attitude  reflects 
a  social  philosophy  none  the  less  influential  be- 
cause it  is  applied  piecemeal  or  because  it  has 
perhaps  not  been  thought  out  by  her  to  its  con- 
clusions. This  is  not  to  plead  for  rigid  opinions  on 
exceedingly  complex  questions.  Reflective  people 
will  continue  to  hold  varying  views  as  to  race 
ideals.  The  points  to  be  emphasized  here  are, 
first,  that  social  case  workers  cannot  get  and 
hence  will  not  express  in  their  records,  a  clear 
idea  of  a  client's  maladjusted  relation  without 
having  already  a  conception  in  mind  as  to  what 
constitute  right  social  relationships;  second,  that 
they  need  to  get  these  latter  concepts  sufficiently 
clear  not  to  run  the  risk  of  promulgating  by  their 
action  in  regard  to  individual  clients  a  conception 
205 


THE  SOCIAL  CASE  HISTORY 

which,  when  expressed  in  general  terms,  they 
would  repudiate,  or  vice  versa.  While  the  record 
is  not  the  place  for  any  direct  expression  of  phil- 
osophy, indirectly  it  may  disclose  what  are  the 
worker's — or  the  supervisor's  or  committee's — 
social  theories  in  any  direction  which  would  affect 
case  treatment,  and  whether  she  has  any  con- 
sistent philosophy  or  is  in  a  state  of  reflective 
confusion.  That  is,  an  acute  person,  reading  a 
succession  of  full  case  histories  written  by  the 
same  worker  would  get  the  latter's  "measure" 
from  the  course  of  treatment  planned  and  pur- 
sued with  regard  to  clients.  It  may  be  objected 
that  one  who  has  a  positive  social  philosophy 
will  not  be  an  impartial  observer  or  recorder; 
she  will  see  things  in  the  light  of  her  theory.  This 
risk  we  must  take,  since  the  alternative  is  point- 
less records  springing  from  treatment  which  is 
directed  hither  and  thither. 

In  addition  to  these  more  general  concepts,  the 
social  case  worker  needs  for  her  practical  purpose 
certain  supplementary  knowledge  of  normal  life; 
namely,  the  standard  of  living  of  families  with  a 
range  of  income  from  the  lowest  regular  wage  up 
206 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

to,  say,  $60  per  week.  This  would  include  not 
only  those  on  the  border  of  dependency  or  below 
it,  but  also,  as  a  basis  of  comparison,  those  who 
are  well  above  the  need  of  financial  help.  By  this 
we  mean  that  the  worker  needs  to  know  what 
people  on  these  varying  incomes  can  have  and 
what  they  must  do  without;  what  sort  of  home 
life  is  possible  for  them;  what  deprivation  in  its 
various  degrees  means,  not  only  in  material  com- 
forts but  in  the  energy  and  ambition  required  to 
keep  a  home  up  to  a  decent  standard;  what  are 
the  standards  in  different  social  groups  below 
which  people  cannot  drop  without  injury  to  a 
sentiment  so  important  to  character  as  self- 
respect;  which  of  these  latter  standards  are 
ethically  false — make  for  pettiness — and  which 
are  socially  beneficial.  One  could  of  course  go  on 
to  include  an  understanding  of  the  customs  of 
different  nationalities.  Quite  aside  from  its  use 
in  helping  to  determine  questions  of  aid,  this 
sort  of  knowledge  is  the  necessary  basis  for  tact 
in  meeting  different  sorts  of  people.  Tact  in  the 
social  worker  is  not  a  matter  of  responsive  emo- 
tion alone;  it  presupposes  an  understanding  of 
207 


THE  SOCIAL  CASE  HISTORY 

others'  way  of  living,  of  their  ambitions  and  ideals 
in  what  we  often  think  of  as  small  things.  These 
small  things,  however, — good  clothes  for  Sunday, 
say — in  so  far  as  they  accord  or  clash  with  group 
standards,  have  an  intimate  bearing  on  self-re- 
spect and  are  therefore  a  significant  factor  in  the 
social  heritage  of  home  standards.* 

Social  maladjustment  the  special  field  of  case 
work. — After  what  we  may  call  concepts  of  nor- 
mal living,  the  history  writer  needs  to  get  clear 
those  of  the  various  forms  of  maladjustment 
in  social  relations:  non-support,  juvenile  delin- 
quencies, unemployableness,  parental  neglect, 
and  so  on.  The  apparent  simplicity  of  such  mal- 
adjustments, the  assumption  of  which  has  guided 
most  of  our  social  action  in  the  past,  analysis 
shows  to  be  misleading.  These  concepts  include 
pathological  and  economic  as  well  as  social  fac- 
tors, all  of  these  factors  bearing  a  causal  relation 
to  each  other.  The  consequent  complexity  in 
cause  and  effect  should  prepare  us  to  find  them 
vague  and  even  unreliable  at  important  points. 

*For  the  application  of  this  to  record  keeping  see 
Chapter  VI,  p.  188. 

208 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

Vagueness  appears,  for  instance,  in  "unemploy- 
ableness."  This  latter  condition  may  be  due  to 
a  man's  lack  of  adaptability  in  getting  along  with 
other  people,  to  slight  stamina — physical  or  ner- 
vous— to  industrial  displacement  late  in  life 
springing  from  a  change  in  machinery,  or,  what 
is  more  likely,  to  the  simultaneous  action  and 
interaction  of  these  factors  or  of  some  other  set 
of  factors  of  a  medical,  economic,  and  social  sort. 
Such  an  interplay  of  factors  appears  in  the  fol- 
low ing  case: 

Aug.  12,  1915.  Mrs.  R.  to  office  with  Michael.  Says 
she  has  done  everything  she  could  to  make  her  hus- 
band better.  She  had  him  sent  to  jail  a  year  or  two 
ago  for  six  months,  and  at  that  time  he  kept  away  from 
liquor  for  over  a  year.  He  is  now  on  probation  in  the 
Third  District  Court.  A  little  over  two  weeks  ago  he 
deserted  her,  because,  as  she  thinks,  he  knows  that  he 
probably  will  be  sent  to  the  Farm  Colony.  She  has 
become  absolutely  discouraged.  He  is  a  bricklayer; 
belongs  to  the  Bricklayers'  Union  on  Frances  St.  Can 
earn  $60  a  week.  Secretary  of  the  Union  told  him  that 
it  was  only  for  her  sake  he  had  kept  him  a  member  of 
the  union  so  long. 

Mrs.  R.  is  not  strong;  has  had  two  operations,  four 
years  apart,  the  last  at  the  Sanders  Hospital.  Would  be 

14  209 


THE  SOCIAL  CASE  HISTORY 

glad  to  work  if  she  could,  but  whenever  she  tries  it, 
breaks  down.  Tried  last  summer  at  the  candy  factory, 
but  had  to  give  it  up  at  the  end  of  two  weeks. 

Has  lived  in  present  house  about  five  months  and 
always  paid  the  rent.  Now  a  month's  rent  is  due  and 
they  are  starting  in  on  the  second  month. 

We  could  call  this  a  case  of  desertion,  of  non- 
support,  of  alcoholism,  or  of  unemployability, 
according  to  the  factor  which  seemed  to  be  most 
operative.  Any  one  of  these  factors  could  be 
regarded  as  either  a  cause  or  effect  of  any  other. 
The  desertion,  a  social  fact,  has  influenced  the 
income,  an  economic:  alcoholism,  a  pathological 
fact,  influences  employability,  which  latter  may 
count  in  desertion.  Whether  this  man  can  be  ac- 
curately described  as  unemployable  we  do  not 
know,  because  we  have  no  adequate  definition,  or 
in  other  words,  no  clear  conception  of  what  is 
involved  in  being  "unemployable."  If  he  is  to  be 
so  regarded,  the  worker  needs  to  learn  and  record 
a  number  of  new  facts,  but  what  all  of  them  are 
one  cannot  yet  say.  Apparently  we  have  over- 
rated the  relative  importance  of  the  intellectual 
endowment  as  compared  with  temperamental  or 
210 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

social  qualities  entering  into  employability  or  as 
compared  with  the  effect  of  environment  and 
training.  What  are  the  qualities  and  circum- 
stances which  taken  together  make  for  occupa- 
tional failure  in  one  man  or  success  in  another  we 
know  only  in  a  general  and  superficial  way,  as 
our  case  histories  testify. 

The  family  as  a  focus  of  maladjustments. — That 
one  of  the  social  relationships  in  which  a  serious 
disturbance  most  frequently  comes  to  the  notice 
of  social  workers  and  in  which  sooner  or  later  all 
malad justing  factors  are  likely  to  converge  is  the 
family.  The  reason  for  such  convergence  is  that 
the  sentiment  of  family  love,  having  for  its  great 
end  the  perpetuation  of  the  race  and  of  its  ideals, 
necessitates  a  considerable  variety  of  outside 
contacts  on  the  part  of  parents  and  children  in 
order  that  this  end  may  be  realized.*  School, 

*"Do  we  not  discern  that  a  part  of  the  system  of  every 
great  sentiment  must  be  a  social  effect  outside  of  the  in- 
dividual in  which  it  has  developed.  .  .  .  The  organ- 
ization of  such  a  system  in  the  mind,  body,  and  behaviour 
of  the  agent  .  .  .  would  be  rendered  ineffectual  but 
for  that  contributory  part  which  is  organized  in  other 
human  beings  and  in  social  institutions.  For  there  is 

211 


THE  SOCIAL  CASE  HISTORY 

church,  recreation,  employment,  benefit  societies, 
trade  unions,  or  social  clubs — each  serves  the 
purposes  of  family  life  in  some  respect  valuable 
to  the  race.  On  the  other  hand,  the  happiness  or 
chagrin  one  meets  in  his  other  relationships  is 
enhanced  or  mitigated  by  its  effect  on  wife  and 
children.  Part  of  a  man's  reward  for  faithful 
labor  is  the  delight  of  telling  his  family  of  a  raise 
in  pay,  and  of  seeing  about  him  the  increased 
home  comfort  that  evidences  success;  part  of 
his  mortification  at  being  blackballed  by  his  club 
is  the  effect  it  will  have  upon  his  children's  stand- 
ing and  upon  their  esteem  for  him.  Even  the 
merely  undeveloped  sense  of  his  relation  to  the 
state  on  the  part  of  the  citizen  who  sells  his  vote, 
bribes  an  official,  or  makes  a  fortune  out  of  a 
national  peril,  will  color  his  training  of  his  off- 
spring. So  far  as  the  social  worker  is  concerned, 
subtle  forms  of  maladjusted  relation,  like  these 

little  that  a  man  can  do  apart  from  others,  and  all  his 
great  ends  require  their  co-operation.  The  ambition  of  a 
Napoleon  obliges  Europe  to  become  organized  in  his 
system,  and  there  to  accept  the  part  which  his  tyranny 
imposes  upon  it."  Shand,  Alexander  F.:  The  Foundations 
of  Character,  p.  123.  Macmillan,  1914. 
212 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

last,  would  not  show  conspicuously  enough  in 
the  home  life  to  be  detected  in  any  reasonable 
amount  of  time,  and  their  existence  must  be 
learned,  if  at  all,  through  a  direct  study  of  the 
relationship  in  question.  The  gross  maladjust- 
ments, however,  with  which  the  social  worker 
ordinarily  deals  are  either  within  the  home  life 
itself,  as  non-support,  desertion,  incompetent 
home-making,  neglect  of  children;  or  else  affect 
it  unmistakably,  as  in  the  case  of  sex  irregularity, 
unemployability,  truancy,  crime. 

Since  on  the  one  side  family  life  is  enriched  by 
the  outside  contacts  of  its  members,  and  on  the 
other  side  the  individuality  of  each  member  is 
developed  by  having  a  number  and  variety  of 
such  relationships  to  choose  from  and  respond  to, 
then  it  follows  that  by  studying  what  are  a 
client's  points  of  contact  with  his  family  and 
with  his  fellows,  by  noting  the  mutual  responsi- 
bilities these  contacts  entail  and  observing  how 
he  fulfils  his  part,  and  by  comparing  the  con- 
tacts he  actually  makes  with  those  his  surround- 
ings give  him  the  opportunity  to  make,  one  will 
obtain  a  working  estimate  of  his  individual  char- 
15  213 


THE  SOCIAL  CASE  HISTORY 

acter  and  of  any  maladjustments  in  his  social 
relationships.*  Take  for  example,  Mr.  X. — 

He  married  young  and  has  a  large  family  of  children, 
gives  his  unbroken  envelope  each  week  to  his  wife,  is 
insured  in  her  favor,  does  regularly  considerable  market- 
ing for  her,  and  does  it  well,  has  taken  liquor  rarely,  and 
never  before  his  children,  goes  out  evenings  only  occa- 
sionally, and  then  with  his  wife  to  chaperone  the  daugh- 
ters; he  has  spent  most  of  his  working  life  with  one  firm, 
and  after  joining  the  union  left  it  because  he  could  get  a 
better  wage  from  these  same  employers  than  the  maxi- 
mum union  requirement,  and  because  the  union  wouldn't 
stand  for  the  extremely  long  hours  without  overtime  pay 
he  puts  up  with;  he  nevertheless  pays  another  man  to 
take  his  place  at  work  Sundays  so  that  he  may  have  a 
quiet  day  for  church  and  for  enjoying  his  family;  he 
handles  horses  so  well  that  they  outlast  those  his  fellow- 
workmen  drive,  and  he  is  entrusted  with  the  training  of 

*  "  Yet  defects  of  the  method  of  observation  as  applied  to 
the  knowledge  of  character  are  plainly  apparent.  For  all 
that  strictly  we  can  know  of  a  man  whom  we  know  only  by 
observation  is  that  his  character  is  that  from  which  his 
conduct  proceeds — his  conduct  that  seems  so  fully  to 
characterize  him.  His  character  is  the  sum  of  unknown  \ 
forces  or  tendencies  which  are  the  source  of  his  conduct.  | 
But  what  these  are  in  themselves,  how  they  operate,  how 
they  are  related  together,  and  how  they  develop  and  decay, 
of  all  this  we  know  nothing."  Shand,  Alexander  F.: 
Opus  cit.,  p.  95. 

214 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

new  horses.  He  attends  church  regularly  with  his  wife 
and  children,  and  put  some  of  his  earnings  into  a  liberty 
bond  only  because  his  clergyman  preached  strongly  such 
patriotic  action. 

A  history  which  should  give  these  facts  about  Mr. 
X.  in  his  social  relations  would  hardly  need  to 
include  the  contented  comment  of  his  wife  that 
he  is  "all  for  his  family,"  in  order  to  show  what 
is  the  dominant  sentiment  in  his  life.  His  love  for 
his  family  is  his  first  idea  and  feeling,  coloring  his 
behavior  toward  his  work,  his  church,  his  union, 
and  even  his  country.  Patriotism,  and  allegiance 
to  the  union  both  meant  less  money  for  his  chil- 
dren ;  the  endurance  of  hard  conditions  of  work, 
more;  faithfulness  to  church  represents  his  ideal 
for  them.  A  man  of  less  singleness  of  interest 
than  this  one  would  be  torn  between  the  con- 
flicting claims  of  family  and  fellow- workmen, 
while  the  parent  whose  dominant  sentiment  was 
public  spirit  would  even  subordinate  the  claims 
of  his  home  to  his  loyalty  to  the  union.  To  a 
greater  or  less  degree  and  in  different  ways  vary- 
ing with  the  individual,  family  sentiment  tinges 
the  sentiments  embodied  in  all  outside  contacts. 
215 


THE  SOCIAL  CASE  HISTORY 

Sometimes  the  influence  of  family  sentiment  is 
deliberate :  anxious  parents  guide  their  children's 
companionships  and  do  all  in  their  power  to  give 
them  such  perceptions  and  feelings  toward  other 
people,  together  with  such  ideals  as  will  establish 
them  in  an  advantageous  social  setting.  At  other 
times  it  is  unconscious:  negligent  or  unwise 
parents  have  as  far-reaching  an  influence  as  the 
devoted  and  wise,  although  an  influence  whose 
course  it  is  often  harder  to  trace.  The  effect 
which  children  may  have  in  coloring  all  of  their 
parents'  social  relationships  is  evidenced  by  the 
illustration  of  Mr.  X. 

In  contrast,  look  at  the  life  of  Mr.  Y.*— 

He  also  married  young,  but  it  was  a  forced  marriage. 
He  also  had  a  number  of  children.  From  the  first,  how- 
ever, he  never  supported  his  family,  having  to  be  helped 
out  constantly  by  relatives.  Even  when  his  family  were 
in  need  he  dressed  well  on  the  excuse  that  he  could  not 
get  or  keep  work  without  good  clothes.  He  is  extremely 
jealous  of  his  wife,  who  upbraids  him  for  not  working  but 
sticks  to  him  in  spite  of  the  remonstrances  of  her  own  kin. 
When  in  liquor  he  talks  coarsely  before  the  children.  On 
the  other  hand,  he  has  never  been  actively  abusive  to 

*See  Diagnostic  Summary,  p.  169. 
216 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

wife  or  children.  He  has  lost  job  after  job  because  he 
refuses  to  take  orders,  preferring  to  be  the  boss  himself, 
and  later  in  life  because  he  became  a  heavy  drinker. 
Although  "when  he  chooses"  he  can  do  well  for  a  time  at 
work  like  that  of  traveling  salesman,  he  does  not  stick 
even  at  that.  He  has  all  along  been  dishonest  in  rather 
small  ways,  at  one  time  signing  an  acquaintance's  name 
to  a  check  for  $2.00,  and  has  served  short  sentences  for 
these  offenses. 

Scant  as  are  these  facts,  they  are  enough  to 
show  that  this  man's  maladjustment  appears 
in  his  social  contacts  with  employers,  relatives, 
the  state,  that  it  focusses  upon  his  family,  and 
that  it  includes  questions  of  character  and  men- 
tality. So  far  as  one  can  judge,  he  has  no  dom- 
inant sentiment  or  sentiments.  His  mental  life 
appears  to  be  adrift.  It  is  significant  that  one 
feels  in  this  instance  more  than  in  the  first  that 
many  additional  facts  are  necessary  for  forming 
a  judgment.  This  may  be  because  in  such  a  case 
the  first  step  in  treatment  which  occurs  to  the 
social  case  worker — a  psychiatric  examination — 
may  lead  to  a  drastic  recommendation  as  regards 
his  fitness  for  self-direction. 

The  interpreting  of  personality  by  its  response 
217 


THE  SOCIAL  CASE  HISTORY 

to  social  environment  shows  to  but  a  slight  extent 
as  yet  in  social  case  histories.  Although  investi- 
gation in  modern  agencies  takes  cognizance  of 
the  client's  social  contacts:  with  family,  rela- 
tives, employers,  landlords,  friends,  and  so  on, 
the  knowledge  of  character  recorded  is  usually 
of  a  surface  description,  unpenetrating.*  To  be 
sure  our  observations  may  seem  sufficient  for 
our  practical  purposes.  But  as  time  goes  on  our 
practical  purposes  must  be  expected  to  spring 
from  more  scientific  conceptions  of  the  nature  of 
social  maladjustment.  The  advance  of  knowl- 
edge in  our  field  entails  on  the  one  hand  a  less 
simple  idea  of  character  than  that  which  gets 
recorded  in  mere  enumerations  of  traits.  We 
must  recognize  it  as  a  system  of  forces  in  which 

*"For  as  with  those  whom  we  are  asked  to  employ,  we 
want  to  know  first  whether  they  are  honest,  sober,  in- 
dustrious, and  understand  the  work  they  profess  to  do; 
so  we  expect  to  be  helped  by  knowing  something  of  those 
with  whom  we  are  likely  to  be  brought  into  contact.  But 
such  lists  of  qualities  do  not  tell  us  anything  of  their  inner 
connection,  and  to  what  limitations  they  are  subject,  and 
what  are  the  chief  systems  of  the  mind  which  elicit,  develop, 
and  organize  them,  whilst  allowing  other  qualities  to  per- 
ish." Shand,  Alexander  F.:  Opus  cit.,  p.  26. 

218 


WIDER  IMPLICATIONS  OF  CASE  RECORDING 

primary  instincts  are  wrought  upon  by  impulses 
deriving  from  man's  innate  social  sensitiveness, 
so  that  a  client's  adjustment,  from  a  "moral" 
point  of  view,  is  to  be  sought  in  part  in  motiva- 
tions of  which  the  client  is  unconscious.  Our 
growing  knowledge  entails  on  the  other  hand  a 
view  of  the  social  environment  as  something  less 
external  to  the  personality  involved  in  it.  Its 
claims  operate  as  strong  suggestions  within  a 
socialized  mind.  The  case  worker,  therefore, 
will  be  increasingly  an  expert  engaged  in  mobiliz- 
ing remedial  influences  by  establishing  relation- 
ships in  her  client's  life:  relationships  that 
energize  salutary  motives  among  all  the  related 
parties.  To  this  end  she  needs  identified  types 
of  conduct  and  situation  in  order  to  focus  upon 
correctly  ascertained  motives  the  influences  at 
her  control.  She  will  accordingly  so  write  her 
case  histories  as  to  clarify  her  own  social  con- 
cepts and  to  leave  documents  contributing  some- 
thing to  the  integrated  insight  of  social  science. 


219 


INDEX 


Abbreviations,  117 
Abnormal  traits.  181 
Albright.  E.  M.,  183 

Ambitions:  of  client  shown  by 
well  selected  descriptive  facts. 
1 88;  and  ideals  shown  in  small 
things.  208 

Answering  inquiries.  61 
Appearance,  description  of,  182 

Bad  housing  as  key  concept,  30, 
33 

Book  of  Narratives,  A.  O.  J.  Camp- 
bell. Jr.,  and  R.  A.  Rice,  183 

Boston  Psychopathic  Hospital 
Social  Service,  108,  149 

Brackets  for  information  about 
the  person  interviewed,  122 

Bruno,  Frank  J.,  135 

Budget  sheet:  as  a  document,  S3~ 
58;  all  money  items  together 
on,  54;  relief  and  income  on, 
54;  and  the  dietitian,  55,  56; 
should  include,  55 ;  and  weekly 
cash  accounts,  56;  objections  to 
the,  56-58;  division  of  material 
between  the  narrative  and,  73 


Calendar,  93 

Campbell,  O.  J.,  Jr.,  183 

Case  Committee,  the,  44,  61,  156, 
157,  158,  206 

Cash    accounts,    weekly,    of   the 
client.  56 

Causal   factors:     and    key    con- 
cepts, 144-150;  in  a  diagnostic 


summary,  146;  marshalling  of 
the,  150;  outline  for,  150;  ac- 
tions of  case  worker  become, 
169,  173;  development  of,  indi- 
cated by  marginal  signs,  176 

Causal  sub-factors,  153,  155 

Character:  traits,  17;  forces 
ill  us.,  197;  marks  vs.  forces, 
197 

Charity  Visitor,  The.  Amelia 
Sears,  20,  86 

Check- marks  for  verified  items 
on  face  card,  50 

Children's  agencies:  accumulat- 
ing facts  to  procure  resources 
for  neglected  children,  32;  divi- 
sion of  the  narrative  by,  53; 
use  of  medical  sheet  by,  58; 
length  of  records  of,  60;  to 
make  a  summary,  ought  to 
know,  63;  and  health  of  whole 
family,  142;  and  facts  on  em- 
ployment, 142;  details  in  plac- 
ing-out  by,  156;  plan  of  treat- 
ment of,  illus.,  159;  boarding 
out  treatment  of,  illus.,  164; 
actions  of,  become  a  causative 
factor,  174 

Chronological:  vs.  topical  organ- 
ization of  narrative,  100-113; 
advantages  of,  100;  advantages 
illus.,  101;  disadvantages  of, 
104;  disadvantages  illus.,  105 

Clarifying  records  of  treatment: 
suggestions  for,  168-180;  by 
periodic  diagnostic  summaries, 
168-175;  by  putting  important 
matter  at  beginning  of  para- 
graphs, 175;  by  marginal 
signs,  176 

Client:  welfare  of,  first  consider- 
ation, 15;  repetition  of  story  by, 


221 


INDEX 


14;  weekly  cash  account  of,  56; 
description  of  surroundings  of, 
134;  present  situation  of,  135; 
ambitions  of,  shown  by  well- 
selected  descriptive  facts,  189; 
social  context  of,  a  web  of  social 
relationships,  201 

Colcord,  Joanna  C.,  88 

Color:  in  recording,  180-199; 
relevant  and  irrelevant,  182; 
and  concreteness,  191-199 

Community  resources:  town  with 
few,  31;  accumulating  facts  to 
procure,  for  children,  32;  in- 
creased variety  of,  51;  new, 
mean  added  contacts  for  the 
client,  52 

Composition  of  the  narrative,  75- 
123 

Conceptions:  vague  and  a  grow- 
ing science,  32-38;  and  pre- 
conceptions, 38-41.  See  also 
Key  conceptions 

Concepts:  constellation  of,  148, 
154;  major,  of  maladjustment 
and  their  treatment  implica- 
tions, 157.  See  also  Key  con- 
ceptions 

Concreteness:  and  color,  191- 
199;  lack  of,  illus.,  191-193 

Conrad,  Joseph,  190 

Customs  of  different  nationali- 
ties, 207 


Day-book,  the,  93 

Description:  of  appearance,  182; 
relevant,  illus.,  184-189 

Descriptive  Writing.  E.  M.  Al- 
bright, 183 

Dewey,  John,  22,  37 

Diagnostic  Summary,  the:  as  a 
method  of  periodic  statement, 
62;  as  part  of  the  narrative, 
143-161;  key  concepts  and 
causal  factors,  144-150;  mar- 
shalling of  the  causal  factors, 


150-156;  and  the  resulting 
plan,  156-161;  outline  of,  150; 
illustrated,  151,  169;  and  the 
time  element,  155;  and  the 
committee  vote,  158;  at  close 
of  each  episode,  168;  changes 
in,  169 

Dictation:  prolix,  81;  explaining 
way  in  which  time  was  spent, 
82;  of  story  as  it  comes  from 
client,  143 

Dietitian,  55,  56 

Direct  quotation,  use  of,  illus.,  194 

Disconnected  narrative  illus., 
164-167 

Doctor,  the:  exact  statement 
form  should  be  recorded,  60 

Documents:  that  constitute  the 
history,  42-74;  the  face  card, 
42-50;  the  narrative,  50-53; 
the  budget  sheet,  53-58;  the 
medical  sheet,  58-60;  the 
summary,  60-69;  use  of  tem- 
porary sheets,  198 

Dramatic  incidents,  use  of,  illus., 
194-106 

Duplications:  between  face  card 
and  narrative,  72 


Economic  disabilities:  not  ac- 
curately described  as  "social," 
202;  close  relation  of,  to  social 
wants,  202 

Elements  of  Record  Keeping  for 
Child"  Help  ing  Organizations. 
Georgia  G.  Ralph,  58 


Face  card,  the:  generally  accepted 
items  on,  20;  two  main  pur- 
poses of,  42;  new,  at  intervals, 
43;  incidental  uses  of,  45-47; 
and  statistics,  45;  and  omis- 
sions, 46;  given  up  by  some 
agencies,  47;  disadvantages  of 
lack  of,  48;  five  requisites  of, 
49;  check  marks  for  verifica- 
tion on,  50;  duplications  be- 
tween narrative  and,  72 


INDEX 


Family:  incohesion  as  a  key 
concept,  33-38;  illustrated,  34; 
vagueness  in  concept,  36;  inco- 
hesion and  difference  in  means, 
37;  the,  as  a  focus  of  maladjust- 
ments, 211-219;  illustration  of , 
216;  the,  and  other  social  re- 
lations, 212;  life  of,  enriched 
by  outside  contacts,  213 

Family  agencies:  length  of  rec- 
ords of,  60;  to  make  a  summary, 
ought  to  know,  63;  details  in 
work  of,  156;  special  difficul- 
ties of  recording  in,  163; 
treatment  recording  ill  us.,  166 

Feeble-mindedness  and  social 
maladjustments,  149 

First  full  interview:  reason  for 
applying,  128;  illus.  of  original 
version  of,  130;  suggested  re- 
vision of  same.  132;  as  part  of 
the  narrative,  134-143;  topical 
organization  of,  135:  organiza- 
tion of,  by  individuals,  136; 
the  same,  by  key  concepts,  136: 
illus.  of  former,  137;  illus.  of 
latter,  139 

Foundations  of  Character,  The. 
Alexander  F.  Shand,  212,  214, 
218 


Galsworthy,  John,  190 

Group    standards    in    the    back- 
ground. 189 


Health:  of  family  in  considering 
health  of  individual  member, 
141;  engrossment  in,  of  one 
member  only  leads  to  ineffec- 
tive treatment,  141;  and  modi- 
fication of  social  attitude,  203 

Historic  stages  in  record  keeping, 
6-18 

Home-maker,  incompetent,  as  a 
key  concept,  30 

Home  sentiment  as  a  key  concept, 


How  We  Think.  John  Dewey,  22, 
37 

"Human    interest,"    picturesque 
details  of,  189-190 


Illustrations  of:  first  stage  in 
recording,  7;  second  stage, 
8-1 1 ;  sizing  up  character,  n; 
key  conceptions,  21,  24,  25, 
27-30;  testing  validity,  27,  28; 
family  incohesion,  34;  uncon- 
scious bias,  39;  summary  for 
co-operating  agency,  65-67; 
addresses  in  the  narrative,  70; 
medical  data  in  the  narrative, 
72;  budget  data  in  the  narra- 
tive, 73 j  earlier  recording,  77; 
accounting  for  time  spent,  82, 
83;  omitting  processes  un- 
wisely, 88,  90;  summarized 
letter,  98;  topical  vs.  chrono- 
logical arrangement,  101-103; 
redundancy,  114,  115;  change 
of  subject  of  sentence,  118; 
changes  in  tense  of  interviews, 
119;  manuscript  devices,  121; 
interpretation  of  facts  by  per- 
son interviewed,  126;  arrange- 
ment of  an  interview,  127; 
original  version  of  first  full  in- 
terview, 130;  suggested  re- 
vision of  same,  132;  organiza- 
tion of  first  interview,  by 
individuals,  137;  the  same,  by 
key  concepts,  139;  diagnostic 
summary,  145,  151,  169;  com- 
mittee vote,  158,  159;  treat- 
ment recording  in  a  boarding- 
out  case,  164;  the  same  in  a 
desertion  case,  166;  relevant 
description,  184-189;  lack  of 
concreteness,  191-193;  use  of 
direct  quotation,  194;  use  of 
dramatic  incident,  194-197; 
unemployableness  as  a  vague 
concept,  209;  social  relation- 
ships as  means  of  estimating 
character,  214;  the  family  as 
focus  of  maladjustment,  216 

Immoral:  conduct  as  a  key  con- 
cept, 23;  girl  as  a  key  concept, 
35 


223 


INDEX 


Impressions  should  be  separately 
stated,  116 

Income  and  relief,  54 

Indention  of  captions  and  sum- 
maries, 122 

Inertia  as  a  key  concept,  23 

Intemperance,  some  implications 
of,  78 

Intensive  words,  use  of,  116 

Interpretation  of  facts  by  person 
interviewed,  125;  illus.  of 
same,  126. 

Interviews:  arranged  by  topics, 
109-113;  organization  of  re- 
ported, 124-143;  form  of ,  124- 
134;  consistent  order  of  items 
in  reporting,  126;  arrangement 
of  suggested,  127.  See  also 
First  full  interview 

Investigation,  10;  record  of  by 
separate  interviews  and  by 
topics,  1 08 

Irrelevant:  data,  27;  details,  82- 
84 

James,  William,  182 
Jarrett,  Mary  C.,  178,  179 

Key  conceptions,  21-32;  testing 
validity  of  tentative,  26;  illus- 
trated, 21,  24,  25,  27-30; 
family  incohesion  and,  33-38; 
causal  factors  and,  144-150 


Laziness  and  mental  disorder,  39 

Letters:  and  the  record,  94-100; 
as  ephemeral  matter,  94-95; 
destruction  of,  95;  and  the 
post-card  habit,  07;  summariz- 
ing, 97;  summarizing  of,  illus., 
98 


Maladjustments:  amassing  evi- 
dence of  typical,  16;  persistent 
relation  between,  149;  and 


feeble- minded  ness,  149;  re- 
curring, 155;  major  concepts 
of,  and  their  treatment  implica- 
tions, 157;  in  social  relations 
source  of  most  applications  to 
family  and  children's  agencies, 
204;  social,  the  special  field  of 
case  work,  208;  apparent  sim- 
plicity of,  misleading,  208; 
the  family  as  a  focus  of,  211- 
219 

Manuscript  devices,  need  of 
standardized,  123 

Marginal  captions,  48,  176,  177, 
178 

Massachusetts  State  Board  of 
Charity,  51 

Medical  diagnoses  and  social  fac- 
tors, 148-149 

Medical  examination  and  the 
medical  sheet,  58-59 

Medical  sheet:  as  a  document, 
58-60;  recommended  to  family 
agencies,  59;  a  foundation  for 
advice,  59;  exact  statement 
from  doctor  should  be  recorded 
on,  60;  division  of  material  be- 
tween the  narrative  and,  72 

Medical  social  work:  by  non- 
medical  agencies,  59:  social 
facts  marginally  noted  in  rec- 
ords of,  177 

Memory  vs.  the  written  record,  13 

Mental  disabilities  and  social  at- 
titudes, 203 

Mental  disorder:  and  laziness, 
39;  sort  of  facts  needed  by 
social  workers  to  report  to  an 
alienist  on  a  case  of.  63;  social 
symptoms  listed  in  cases  of, 
140;  and  modification  of  social 
attitudes,  203 

Mental  make-up  and  social  mal- 
adjustments, 149 

Minneapolis  Associated  Charities, 
43,  135 

Myerson,  Dr.  Abraham,  197 


224 


INDEX 


Narrative:  as  a  document,  50- 
53;  division  of  the,  53;  sepa- 
rate, for  each  child,  53;  ad- 
dresses in  body  of  the,  70;  du- 
plications between  face  card 
and,  72:  between  medical 
sheet  and.  illus.,  72;  between 
budget  sheet  and,  73;  com- 
position of.  75-123;  standards 
of,  as  affected  by  the  type- 
writer, 75-82;  ephemeral  mat- 
ter in,  82-09;  interrupted  by 
irrelevant  details,  82-84;  topi- 
cal vs.  chronological  organiza- 
tion of,  100-113;  rhetoric  in 
the,  113-123;  in  detail,  124- 
199;  organization  of,  of  re- 
ported interviews,  124-134;  of 
first  full  interview,  134-143; 
diagnostic  summary  in  the, 
143-161;  record  of  treatment, 
162-180;  "color"  in  the,  180- 
199;  entry  of  the  plan  in,  156; 
disconnected,  162;  suggestions 
for  clarifying,  168-180;  lack  of 
concreteness  in,  illus.,  191 

Non-support  cases:  relevant  facts 
in,  51-52 

Normal  and  abnormal  traits,  181 


Omissions:  revealed  by  face  card, 
46 


Paleness:  and  bad  personal  hy- 
giene, 24;  and  insufficient 
sleep,  24;  and  innutritive  food, 
24 

Paragraphing:  under  marginal 
captions,  48;  plan  of,  121; 
place  important  matter  first  in, 
175 

Permanent  facts  on  the  face  card, 
49 

Person  interviewed:  information 
about,  122;  impressions  of ,  122 

Person  referring,  statement  from, 
128;  the  same,  illus.,  130 

Personality:  degree  of  interest  in, 
81;  emphasizing  facts  of,  by 


marginal  signs,  178;  as  identi- 
fied by  its  response  to  social 
environment,  179,  217-219 

Phases  in  treatment,  168 

"Phases  of  the  Economic  Interest," 
Henry  Waldgrave  Stuart  in 
Creative  Intelligence,  76 


Plan:  the  resulting,  156-161; 
details  of  treatment  may  ob- 
scure, 156;  constant  revising 
of,  161 

Preconceptions,  38 

Prejudice,  39 

Present  situation  of  client,  135 

Primary  concern  of  case  work  is 
with  social  relationships,  201 

Processes:  temporary  value  of 
certain  details  of,  illus.,  84,  91; 
test  of  details  of,  is  relevance  for 
future  treatment,  86;  certain, 
alter  the  client's  situation,  87; 
omitting,  unwisely,  illus.,  88, 
90;  details  of,  useful  in  the 
supervision  of  a  large  staff,  93; 
omit  marginal  signs  in  record- 
ing temporary,  177;  temporary, 
recorded  on  temporary  sheets, 
198 

Psychiatric  social  work,  202 

Psychology:  and  family  inco- 
hesion,  35 

Purpose:  of  a  case  history,  5-18; 
in  choice  between  concepts,  24; 
in  treatment,  160 


Ralph,  Georgia  G.,  58 

Reason  for  applying  to  agency, 

128 
Recurrent  facts,  significance  in, 

37 


225 


INDEX 


Red  ink:  for  summaries,  61;  for 
important  facts  and  topical 
captions,  zaz;  for  recorded 
votes,  157 

Redundancy  of  expression,  113 
Relevancy  illus.,  27,  28 

Relief:  earlier  entries  of,  7,  10; 
and  income,  54;  the  budget 
sheet,  the  dietitian,  and  more 
adequate,  55;  public,  visitors, 
55 

Repetition:  of  story  by  client,  14 
Review  of  case  history,  32 

Rhetoric  in  record  writing,  113- 
123;  verbosity,  113-116;  no 
merit  in  brevity  for  its  own  sake, 
113;  redundancy  illus.,  114- 
116;  intensive  words,  1 16;  ab- 
breviations, 116;  perspective 
in  sentence,  117;  subject  of 
sentences  illus.,  118;  changes 
in  tense  of  interviews  illus., 
119;  planning  of  paragraphs, 
121 

Rice,  R.  A.,  183 

Richmond,  Mary  E.,  62,  144,  145 


Sears,  Amelia,  20,  86,  87 

Selection  of  material,  a  basis  for, 
19-41 

Self- betterment,  records  as  means 
of,  18 

Sex  misconduct,  distinctions  in, 
36;  constant  factors  in  a  cer- 
tain type  of,  149 

Shand,  Alex.  F.,  212,  214,  218 

Significance:  of  the  fact,  21;  of 
obstinate  refusal  to  move,  22; 
for  treatment,  20-41 

Significant  information,  failure  to 
select,  64 

Similar  facts  kept  near  together, 
49 


Social  agencies:  records  of,  as 
basis  for  study  of  their  work, 
15;  standardizing  work  of,  16; 
in  towns  with  few  community 
resources,  31;  use  of  face  cards 
by,  47;  non- medical,  doing 
medical  social  work,  59;  sum- 
maries for  the  use  of  other,  62- 
69;  form  of  summary  for  use  of , 
65-67;  obligation  of,  to  see 
their  clients  through  their 
troubles,  175;  maladjustments 
in  social  relations  bring  most  of 
the  applications  to,  204 

Social  case  history,  the:  purpose 
of,  5-18;  defined,  5;  historic 
stages,  6-1 8;  ulterior  purpose 
of,  14-18;  review  of,  32;  docu- 
ments that  constitute  the,  42- 
74;  earlier  recording  of,  illus., 
77;  later  recording  of ,  illus.,  80; 
wider  implications  of,  200-219 

Social  case  worker,  the:  frequent 
changes  in,  13,61;  compi  trine 
of,  as  interpreter  of  social  rela- 
tions, 204,  205;  social  philoso- 
phy of,  204;  concepts  of,  with 
regard  to  obligations  of  parents, 
the  relation  between  the  in- 
dividual and  the  state,  and  the 
value  of  public  aid,  205;  course 
of  treatment  pursued  by,  as  a 
measure  of  his  philosophy,  206; 
supplementary  knowledge 
needed  by,  206-208;  an  expert 
in  establishing  relationships, 
219 

Social  diagnoses:  can  they  be 
named  and  classified  with  pre- 
cision, 149;  conduct  emphas- 
ized in,  154;  tentative,  157,  160 

Social  Diagnosis.  Mary  E.  Rich- 
mond, 62,  144,  145 

Social  rehabilitation:  as  a  pur- 
pose in  choice  of  concepts,  25 

Social  relationships:  and  the  cli- 
ent, 201-208;  certain,  named, 
201;  the  primary  concern  of 
social  case  work,  201;  the  case 
worker  as  interpreter  of,  204- 
208;  concepts  of  the  different, 


226 


INDEX 


204;  the  family  and  other,  212; 
working  estimate  of  client's 
character  through  study  of  his, 
213;  illustrations  of  this  esti- 
mate, 214-217 

Stages  in  record  keeping:  first 
stage  illus.,  7;  second  stage 
illus.,  8-1 1 ;  third  stage,  11-14; 
fourth  stage,  14-18 

Standard  of  living,  206 

Standardizing:  work  of  social 
agencies, 


16;    manuscript  de- 


vices, 123 

Statistics:  and  the  face  card,  45; 
of  occupation,  45;  of  literacy, 
46 

Stenographer:  trained  to  look  out 
for  mechanical  details,  71 

Stuart,  Henry  Waldgrave,  75.  76 

Summary,  the:  as  a  document, 
60-69:  separate  sheet  for,  61: 
uses  of,  61-64;  and  other  social 
agencies,  62-69:  form  of  sum- 
mary, 65-67;  objections  to,  by 
other  agencies,  63;  as  a  per- 
manent part  of  the  record,  65; 
different  for  different  agencies, 
68;  should  include  no  fact  not 
in  record,  69.  See  also  Diag- 
nostic summary 

Supervisor,  14,  44,  93,  157,  206 
Suspended  judgment,  41 


Temporary  sheets,  use  of,  198 

Testing  validity  of  tentative  con- 
cepts, 26 

Tickler,  93 

Topical  arrangement:  of  sum- 
maries, 68;  vs.  the  chrono- 
logical arrangement  of  mate- 
rial, 100-113;  illustrated,  102; 
advantages  and  disadvantages, 
107-109;  within  the  inter- 
view, 109;  the  same,  illus.,  no 


Topical  captions,  121 

Treatment:  significance  for,  19; 
trying  out  forms  of,  26;  rel- 
evancy for,  illus.,  27,  28;  al- 
ternative treatments,  30;  be- 
ginning of  diversified,  50; 
record  of,  162-180;  details  of, 
may  obscure  plan,  156;  im- 
plications of  major  concepts  of 
maladjustment,  157;  evidence, 
157;  purposefulness  of,  160; 
suggestions  for  clarifying  rec- 
ords of,  168-180;  succession  of 
phases  in,  168;  implications 
for,  200 

Typewriter,  the:  and  the  face 
card,  49;  and  narrative  stan- 
dards, 75-82 


Uncertainties  of  entry,  70-74 
Unconscious  bias  illus.,  39 
Underlining,  121 

Unemployableness:  as  a  con- 
ception, vagueness  of,  209;  il- 
lustrated, 209-211 


Vagueness:  cure  for,  32;  in  col- 
lective social  thinking,  32; 
through  lack  of  corroboration, 
33;  in  our  social  thinking,  36; 
of  concept  of  unemployable- 
ness,  209 

Verbosity,  113-116 

Visitor,  place  for  name  of,  124 

Vote:  test  of  the  committee's, 
157;  recorded  in  red  ink,  157; 
committee's,  and  the  diagnostic 
summary,  158;  illus.  of  the 
same,  158,  159 

Welfare  resources,  growth  of,  12 

Wider  implications  of  case  record- 
ing, 200-219 


227 


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